Georgia bill would rein in pharmacy middlemen; supporters say it could save local drugstores

ATLANTA, Ga. (Atlanta News First) — Georgia lawmakers are weighing a bill that would put new limits on pharmacy benefit managers (PBMs). These powerful middlemen help set the prices that employers and patients pay for prescription drugs.

Supporters say the measure could keep locally owned, independent pharmacies from shutting their doors, especially in rural parts of the state. Industry groups for insurers and pharmacy benefit managers warn that if PBMs have to pay pharmacies more, employers and insured customers could end up footing the bill.

House Bill 810 would do three main things:

• Create a ceiling so pharmacy benefit managers cannot charge above a national market price for a drug
• Create a floor so they must at least cover the full cost of the drug
• Add a dispensing fee of about $10 to $11 per prescription for the pharmacy

Independent pharmacist Ira Katz, who owns Little Five Points Pharmacy in Atlanta, said PBMs are “making up prices” and called the current system “fraud.”

Katz said he can buy a cancer drug for less than $80, but a PBM then bills the employer at more than 24,000% above the national average drug cost.

“There are days I lose money filling prescriptions,” Katz said. “Pharmacy benefit managers are making up prices, and employers and patients have no idea.”

The Georgia Pharmacy Association reports more than 200 pharmacies have closed in Georgia since 2015, many of them independent stores. The group estimates PBMs have charged Georgians about $400 million above the national average drug acquisition costs in recent years.

State Rep. Rick Jasperse, R-Jasper, the bill’s sponsor, said he was motivated by his father’s experience as a small-town pharmacist and by recent closures in his own district.

“His nickname was ‘Doc Jasperse,’” he said. “Because people came to him on Saturday, Thursday night, Monday night – ‘What’s wrong with me, what can I do?’ Pharmacists have been the glue in our health care system forever.”

Jasperse pointed to Bell’s Pharmacy in his north Georgia district, which recently closed and is now a sandwich shop.

Public health researcher Natalie Crawford of Emory University said independent pharmacies are often the only health care access point in rural and low‑income communities.

“We are literally losing health care access in the communities that need it most,” Crawford said. “When an independent pharmacy closes, rural and low‑income Georgians lose a first‑line provider.”

Crawford described PBMs as “an opaque intermediary with disproportionate leverage,” saying they have “all the control” while most patients do not even know who they are.

During a bill hearing last month, southwest Georgia pharmacist Nikki Bryant told lawmakers she now bakes biscuits and cakes before dawn to help keep her two independent pharmacies open.

“I love my patients, and I want to be there for them,” Bryant said.

The Georgia Association of Health Plans and PBM industry representatives told lawmakers that if the bill forces higher payments to pharmacies, those costs are likely to be passed on to employers and people covered by commercial insurance plans.

“Who is going to foot the bill for these changes when you do them? Our contention is, it’s going to be the ratepayer — the individual insured and the employer,” said Jesse Weathington, president of the Georgia Association of Health Plans.

Proponents of the bill argue that PBMs have room to absorb more of the cost without shifting it to patients.

The bill has cleared a key House committee. It must pass the full House by Friday’s crossover deadline to remain alive this session.