COULD PHARMACY BILL COST CONSUMERS?

A bill promoting independent pharmacies passed the N.C. House in 114-0 vote in April, suggesting little controversy. But the legislation is opposed by drug companies and national drugstore chains that contend it will hurt consumers by imposing various mandates on pharmacy benefit managers, or PBMs.

The changes would prompt a $10.24 fee for each prescription drug dispensed in the state, according to critics of the bill.

Reps. Chris Humphrey of Lenoir County and Wayne Sasser of Stanly County say House Bill 246 is intended to even the playing field for independent pharmacies, which the lawmakers say are becoming scarce because of unfair practices of PBMs and larger chains. (Sasser is a retired pharmacist.)

Like everything in health care, the issues are complex, especially given the arcane nature of PBMs, which are third-party companies that manage prescription drug benefits for large employers and health insurers. Three owners now have more than 80% of the PBM market: CVS Health's CVS Caremark; United Healthcare's OptumRX; and Cigna's Express Scripts, according to U.S. Rep. James Comer, a Kentucky Republican who has criticized the industry's practices.

PBMs sign agreements with clients that allow for discounted prices on drugs. Owners of independent pharmacies, which lack similar...