Tom Field wonders how much longer his Corvallis pharmacy can keep losing money on prescriptions — and he is pinning his hopes on a bill headed for the Oregon Legislature this month.
It’s a “David and Goliath” battle, he told The Lund Report, adding that, in terms of survival, “lots of indie pharmacies are looking at months —not years.”
Retail pharmacies provide important health services to patients. But their numbers keep dwindling and Oregon now has the second-fewest of them in the nation on a population basis.
Oregon lawmakers have tried to stem this trend by addressing what pharmacists say is the problem: unfair, below-cost reimbursements from the middlemen companies used by insurers known as pharmacy benefit managers.
But those efforts have not borne fruit. The number of licensed pharmacies in Oregon dropped from 772 to 698 between 2021 and 2024, according to state licensing data.
“What other business has to fight tooth and nail with legislators just to break even with their business?”
A lot has happened since the Legislature’s previous attempts to regulate the drug coverage middlemen. The Federal Trade Commission last year sued three giant pharmacy benefit companies for allegedly manipulating the prices of life-saving drugs. The U.S. Justice Department has opened a probe into unlawful efforts to restrict competition.
And last month in Congress, bipartisan consensus reform attempts addressing the companies were scuttled after a broader spending deal it was attached to was killed by incoming President Donald Trump and tech mogul Elon Musk.
Despite the national scrutiny of the issue, state Rep. Rob Nosse, the Portland Democrat, doesn’t know if pharmacist Tom Field will get the relief he’s hoping for.
“I won’t pull punches here,” said the House Behavioral Health and Health Care Committee chair at a Jan. 7 Oregon Health Forum panel discussion. “I think it’s going to be difficult and controversial.”
The pharmacist’s plight
Field, the longtime manager and co-owner of Rice’s Pharmacy and Gifts, told The Lund Report he continues to lose money on the medications it dispenses. The gap between what he pays per prescription for Eliquis — a common drug used to reduce blood clots — and what he receives in PBM reimbursement is $40, for example.
But if he doesn’t stock a variety of drugs like Eliquis, customers go elsewhere.
“(Pharmacy benefit managers) can underpay us on any prescription they want,” he said. “And they have no incentive to prove that is a reasonable price.”
Meanwhile, insurers and their pharmacy benefit manager allies continue to steer customers he has served for decades to other pharmacies that are part of their networks, he added.
“Trying to fix a piece of this giant system is highly complicated and problematic. We need to look at it from top to bottom.”
Under the new bill sponsored by Nosse, patients would be allowed to pick their own pharmacy. Also, pharmacy benefit managers would pay a per-prescription dispensing intended to help pharmacists like Field.
The new bill’s number is not yet public. Bills are scheduled to be released publicly Jan. 13, and the session starts Jan. 21.
In 2023, Oregon state auditors concluded that other states do a better job of regulating the middlemen companies.
Opposition, mixed results with previous efforts
Oregon lawmakers have been trying to better regulate pharmacy benefit managers for more than a decade. Oregon lawmakers passed a bill last year that required pharmacy benefit managers to obtain licenses from the state while giving regulators more oversight and the ability to impose penalties. In 2023, a bipartisan bill that would have changed how pharmacy benefit managers pay pharmacists died on the last day.
The new Nosse bill, which is similar to the one that died in 2023, would prevent pharmacies from losing money on prescriptions, Brian Mayo, executive director of the Oregon State Pharmacy Association, told The Lund Report.
“What other business has to fight tooth and nail with legislators just to break even with their business?” he said.
But opponents say the higher fees for pharmacists will lead to higher costs for the people buying the drugs.
The trade group representing the middlemen is called the Pharmaceutical Care Management Association. In a statement, Bill Head, an executive with the group, said that the bill would hurt insurers’ ability to manage drug costs, for instance by prohibiting the companies from charging pharmacists more for drugs than they are reimbursed by insurers.
A lobbyist representing pharmacy benefit managers, who spoke on condition of anonymity, put it more simply.
“It will be reflected in out-of-pocket costs for consumers and in premiums,” the lobbyist said. “There is not a magic mystery chest of reimbursement dollars.”
The League of Oregon Cities generated some of the last-minute opposition that in 2023 killed an earlier version of Nosse’s bill. The group argued that the dispensing fees would saddle city governments with millions more in prescription drug costs.
Scott Winkels, a lobbyist for the group, told The Lund Report that his group is still analyzing the new legislation but expects to have similar concerns about costs for municipal workers, their employers and retirees.
Winkels said, while calling for a broader look at the problem of drug prices.
“Trying to fix a piece of this giant system is highly complicated and problematic,” he said. “We need to look at it from top to bottom.”