Pharmacist: This bill would drive up prescription costs for all in NC | Opinion

When I was 13, I was riding my bike and noticed weeds sprouting outside my local pharmacy. I was picking them from the concrete when the pharmacy owner noticed me, walked outside and asked if I wanted a job. Little did I know it would put me on a path to becoming a pharmacist.

I started cleaning up the pharmacy after hours. I later became a cashier, then a technician at the pharmacy. Eventually, I graduated from pharmacy school and became a licensed pharmacist. Now, 25 years later, I’m a clinical manager at one of CVS Health’s specialty pharmacies in Raleigh.

I take great pride in helping each patient, many of whom have rare or chronic conditions like rheumatoid arthritis, cancer, HIV or multiple sclerosis and need specialty medications.

A father came to my pharmacy one day seeking specialized medicine for his daughter, who was struggling with a rare seizure disorder. The seizures were worsening and the father was confused by the treatment process and growing increasingly worried. He was at a loss for how to help his child.

We sat and talked for as long as he needed. I explained the treatment process for the new, cutting-edge medication the doctor had prescribed. Then came the father’s concern about the cost — $1,001 for a 60 milliliter vial that would only last his daughter two months. Big drug companies regularly set high list prices for specialty medications, particularly on the most new and promising ones, often upwards of $200,000 per year.

In the face of these high prices, pharmacy benefits managers (PBMs) play a critical role, helping health plans and employers provide patients with a pharmacy benefit that helps control costs and provide access to medications they need. In 2022, for example, CVS Caremark, the PBM of CVS Health, held overall prescription drug cost growth for our clients to 5.3% — the sixth consecutive year we’ve kept this trend to single digits.

We also go the extra mile to find ways to help members save. For this father, my team and I worked to identify available financial assistance to help address the high cost of the drug. Our efforts resulted in us filling each seizure medication with no out-of-pocket cost to his family. As the new medicine started to work, his daughter’s condition began to improve and today she no longer suffers from seizures.

This father and daughter are among the millions of North Carolinians CVS Health serves. That’s why I was alarmed to hear that lawmakers in the N.C. General Assembly are considering a bill that would limit the pharmacy benefits North Carolinians rely on.

House Bill 246 would raise costs for businesses, families and taxpayers, including significant increases in the cost of specialty medications. It would add a state-mandated $10.24 dispensing fee to every prescription. These fees are generally included in the price paid by patients at the counter, or if absorbed by the plan, could lead to higher insurance premiums.

This bill prohibits specialty pharmacy networks and would require that any pharmacy be allowed to dispense specialty drugs, whether or not they can provide the appropriate level of clinical care and support for patient safety. The bill prohibits patients from receiving prescriptions via home delivery at a discount, hurting those who, because of illness, age or finances, prefer to get prescriptions by mail.

The bill does nothing to improve access to medications or make medications more affordable, and if patients cannot afford their medication many of them might postpone or skip necessary care.

Dealing with a complex or chronic disease can be a stressful and trying situation for any patient. Receiving the needed medication should not be.

As our representatives in Raleigh seek to tackle the issue of prescription drug affordability, it is essential that they keep in mind the valuable role pharmacy benefits managers play and instead focus on the true source of rising costs: the high prices set by big drug companies. We must make access to healthcare more affordable — and not more difficult. North Carolinians deserve nothing less.