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Floor Speech
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Mr. MORAN. Madam President, I am here on the Senate floor today to call attention to my colleagues. I want them to recognize--and, really, Americans to recognize--the significant crisis that is happening not only in my home State of Kansas but across the country. All of us face this in our home States. The independent and community pharmacies in our Nation have been struggling for years to survive, and their situation, unfortunately, is deteriorating rapidly.
Independent and community pharmacies play an invaluable role in the healthcare of our country and especially in rural communities, like those in my home State. For many Americans, the local pharmacist is not just a convenient healthcare provider, but it is also someone with whom they feel most comfortable in receiving medical advice.
I remember my dad, into his nineties, declined to go see the doctor because he knew they would find something wrong with him. But when he had a cup of coffee at the drugstore, he talked with the pharmacist, who provided him with healthcare, occasionally putting a blood pressure cuff on his arm and suggesting to my dad: Ray, you need to go to the doctor.
They are really important people in our communities, and they are highly trusted; and their advice is invaluable as we try to make certain that all Americans are more healthy. Local pharmacists know their patients, their health situations, and even their families, as is the norm in tight-knit rural communities.
The service occurring at a local pharmacy is not simply one for physical medication but offers the relational aspect so often missing in today's healthcare system and, in fact, in today's world. Community pharmacies do not just dispense medications. They build relationships with their patients, and they offer a familiar face and trusted adviser, extending value far beyond their role as just a provider of medication and prescription drugs, although that is their profession.
But despite their irreplaceable role in America's rural communities, from 2003 to 2021, the number of independently owned retail pharmacies declined in rural areas by 16 percent. Through the COVID pandemic and in its aftermath, local pharmacies have been hit hard by the same difficulties our entire healthcare system and infrastructure are facing: high inflation, nonexistent workforce, and supply chain shortages.
However, in addition to these factors experienced by many, pharmacies face additional significant challenges that threaten their solvency and are forcing an increasing number of independent and community pharmacies to close. The growing challenges with the 340B Drug Pricing Program and actions of participating manufacturers are reducing the revenues for contract pharmacies. While 340B was created to ensure low- income and uninsured patients have access to discounted drugs, pharmacies have relied upon the program for revenue via contract pharmacy arrangements, a policy that Congress ought to codify within the 340B statute.
Another factor is the actions of pharmacy benefit managers, or PBMs. We have three committees in the U.S. Senate, all which have passed legislation dealing with PBMs, but none of those pieces of legislation has come to the Senate floor--PBMs that, unlike any other sector of the healthcare industry, have operated without oversight and regulation for years.
The obscurity of their industry allows PBMs to argue that they are helping to keep prescription costs lower for patients while ensuring a higher reimbursement for pharmacies. Recent studies, investigations, and real-life experiences of our independent and community pharmacies and their patients tell us the exact opposite is true.
I hear this from my pharmacists across Kansas. It used to be, early in my days in the U.S. Senate and even in Congress, that the gathering place in the community and a nice enjoyable place to visit was the community pharmacy, the community's drugstore. Today, if you enter the drugstore as an elected official, you will hear the difficulties those pharmacists are facing in their profession and in their business. Part of that is the story of PBMs and the PBMs' clawbacks from reimbursements already made to the pharmacists, rebates that did not reach patients and went instead to the PBMs. Vertical integration and unfavorable terms offered to 340B contract pharmacies have become increasingly frequent and the common practice of PBMs.
In addition to actions taken by the PBMs, local pharmacies also recently have been forced out of or are unable to serve TRICARE beneficiaries. Two years ago, TRICARE began a new contract with Express Scripts, the subsidiary owned by Cigna. The new Express Scripts contract offered to interested pharmacy participants offered reimbursement rates that were far too low for many of our pharmacies or pharmacists to accept. The pharmacists did not have the ability to negotiate the reimbursement rates with Express Scripts. It was a ``take it or leave it.''
Without negotiations and unable to afford the offered reimbursement rates, countless numbers of local pharmacies in Kansas could not participate in the new TRICARE network with Express Scripts. In addition to the community pharmacies' desire to serve veterans, Active- Duty military members, and their families, the costs associated with TRICARE prevented them from doing so.
When the costs of acquiring and dispensing a drug are higher than the reimbursement rates, a business--a pharmacy--simply cannot make that math work and stay solvent. Yet we continue to ask our community pharmacists across the Nation to do that each and every year, to make that situation work year after year.
While perhaps you can get by for a year or maybe two, you can't get by year after year after year. It is not an exaggeration to say that the Nation's independent and community pharmacies are facing a crisis, and if Congress does not act, a significant number of local pharmacies will be forced to close. We frequently discuss the high rate of rural hospital closures, but rarely do we ever discuss the parallel crisis of losing rural pharmacies at this increasingly alarming rate.
I am told by the Kansas Pharmacists Association that 32 percent of community pharmacies across the country are considering closing this year. Unfortunately, I know that 32 percent includes a vast number of Kansas pharmacies. As of 2021, Kansas is one of four States with the most counties lacking sufficient access to a pharmacy.
What I am saying is that there is already a problem of access. But with the trend that now presents itself, more and more Kansans--more and more Americans--will have less access or no access to a pharmacy.
Today, many of our healthcare needs are met by prescription drugs, and yet that will not be an option for many Americans.
So often we take for granted the healthcare infrastructure we have in our Nation, from hospitals and community health centers to specialists and pediatricians and primary care practices. No matter where an individual is seeking care, one place that is a common denominator for the entire healthcare system is the pharmacy. Independent and community pharmacies in Kansas and across the Nation are the one place where a patient can go to fill their medication, see a friendly face, and know that local access to care is there for them when they need it.
We are asking for miracles from the community and independent pharmacies to remain solvent through a barrage of unfair situations, none of their own making. They deserve better than what we are asking from them. And just as they offer lifesaving services to Americans, Congress ought to heed the warnings from community pharmacists and offer lifesaving policies and legislation to them.
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