Grassley meets with rural pharmacies
Staff from Clayton Drug pose with U.S. Senator Chuck Grassley, who attended a Q&A with local pharmacy owners and health care providers on Sept. 25, at the Strawberry Point Clayton Drug location. (Photo by Kaitlyn Kuehl-Berns)
By Kaitlyn Kuehl-Berns | Times-Reigster
On Sept. 25, U.S. Senator Chuck Grassley visited Clayton County to talk with rural pharmacy owners and healthcare providers about issues facing their industries.
Grassley began his career in politics when he was elected to the Iowa House of Representatives in 1959. He served in that capacity until 1974, when he was elected to the U.S. House of Representatives.
He has held his current position in the U.S. Senate since being elected in 1980. He recently became both the longest-serving Republican senator and the oldest current member of Congress, with more than 65 years of public service at age 92.
Jennifer Clayton, the owner of Clayton Drug, hosted the meeting at her Strawberry Point location. Clayton Drug also has pharmacies in Elkader and Sumner. Clayton and Ryan Frerichs, the owner of Meyer Pharmacy in Waverly, addressed Grassley with their concerns on issues facing rural pharmacies.
Beginning discussions talked about the value rural pharmacies provide to both patients and the community. Clayton shared, “If we weren’t here, patients would have to drive half an hour away or more to get their medication.”
Other health care professionals added that having a local pharmacy is vital to the survival of rural hospitals, clinics and nursing homes. Beyond health care, a local pharmacy supports the local economy by allowing residents to shop local, provide jobs and be a trusted place for medical guidance.
Issues facing rural pharmacies in America include drug shortages, staffing challenges, increased workload and rising drug costs. The focus of the meeting centered on the complex and confusing pricing system driving drug costs.
Pharmacies purchase medications from wholesale distributors who buy directly from drug manufacturers. When a patient fills a prescription using insurance, pharmacy benefit managers (PBMs), a third-party company working on behalf of the insurer, determines how much a pharmacy will be reimbursed for the medication.
Patients pay the co-pay at the counter and pharmacies receive reimbursement from the insurance company or PBM later. Because PBM represents so much of the market, they can negotiate with drug manufacturers to receive rebates on the medication. These rebates offer little benefit to pharmacies or patients, as the savings go to PBMs and insurance companies after the medication has already been paid for and dispensed.
The system is further complicated by market control. In both the wholesale market and PBM industry, a handful of businesses dominate the market. For wholesale, McKesson, AmerisourceBergen and Cardinal Health manage about 90 percent of the nation’s pharmaceutical distribution. When it comes to PBMs, CVS Caremark, OptumRx and Express Scripts manage 80 percent of prescription claims. These three PBMs are also all owned by insurance companies.
Grassley commented on the market dominance and insurance ownership of PBMs, stating, “That’s kind of an incestuous relationship. [Through legislation] the goal is to get everything out in the open so we know how they do business and understand whether the process is benefiting the consumer, local pharmacists, pharmaceutical companies, whole sales and PBMs.”
Frerichs expressed support for creating transparency in the process. He said, “If you look at the facts, pharmacies are going out of business, patients are paying higher drug prices and PBMs are on the Fortune 15 list.”
Grassley shared ways he and his staff have advocated for these changes through writing letters, speaking with U.S. Secretary of Health and Human Services Robert F. Kennedy Jr., supporting bills that address the issue and bringing awareness to issues the system causes for constituents.
He gave updates on bills meant to address the issue currently in Congress, but explained different committees have jurisdiction over different components, so it takes a group effort to accomplish it. Grassley said he is seeing more progress and support of the topic in Congress and hopes to see more.
Later in the meeting, Grassley was asked if he would support legislation to include rural pharmacists among the professions eligible for scholarships or grants in high-need fields, as a solution to the lack of people exploring or pursuing education in the field. He said he would support this.
Clayton shared how the day-to-day work of pharmacists has changed over time. She said the administrative tasks required to “navigate poor reimbursement and high acquisition costs of our inventory takes up 80 percent of my time when it should only be 10 to 15 percent.”
Clayton expressed frustration with this shift, explaining that, like many others, she got into the profession to care for and help the individuals who come in.
Besides the burden of administrative duties, the system’s cash flow also negatively impacts rural pharmacies. It creates financial challenges that can force them to stop carrying certain medications.
Clayton shared her experience with customers, saying, “We tell people, ‘I’m sorry, I can’t afford to take a $500 loss on medication.’ They understand, but the look on their faces when they walk out the door is hopelessness.”
After the meeting, Clayton shared more about her experience as a rural pharmacy owner. She went to pharmacy school at the University of Iowa and graduated in 2008, then worked as a retail pharmacist before buying the Clayton Drug Pharmacies in 2012.
Reflecting on her career, she shared, “I love this or I wouldn’t keep doing it.” Sharing information and helping people is what she and other pharmacists are passionate about.
Clayton said, “This is an industry that affects everyone. We are, to a point, where everyone can relate—whether it’s your mom that’s in a nursing home, a dad that can’t get his inhaler or you yourself can’t get your seizure medication. More people are seeing what is happening and understanding what’s going on with pharmacies.”
Clayton hopes more people pay attention to the issues facing rural pharmacies and their patients. She added, “I’m hopeful that this is a starting point and, with the added attention and help from Senator Grassley and others, we can get there.”
