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Steil, thanks very much.
>> Thank you.

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>> On health care, we
continue our coverage of

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prescription drug prices,
which continue to climb for

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patients and pharmacies,
while coverage of them

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continues to plummet. In RX,
uncovered "Here& Now",

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producer Marissa Wojcik
examines the complex systems

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driving these trends. This
week, we look at the impact

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on pharmacies, both big and
especially small, and why

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their disappearance is
hurting patients.

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>> We have been in business
for over 70 years.

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>> The local drugstore was
once upon a time a staple in

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communities across the
country.

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every month and it's scary,
and we think about how how

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long can we last?
>> Today, whether it's the

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local drugstore or a chain
pharmacy, the brick and

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mortar presence is dying.
>> The feasibility of having

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an independent pharmacy is
becoming very challenging.

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>> Nicole Schreiner is the
new CEO of Streu's Pharmacy

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in Green Bay and president
elect on the board of the

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Pharmacy Society of
Wisconsin.

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>> We get up in the morning
because we want to truly

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help serve our patients.
>> Alongside her commitment

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to the mission, she takes on
her new dual roles in one of

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the most challenging times
for pharmacies. From 2010 to

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2021, 30% of drugstores in
the US closed. Last year

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alone, 2300 pharmacies
closed, half of them being

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independent or mid-sized
businesses.

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issue for patients. We
oftentimes talk about in

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rural areas. You know,
patients having to travel,

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you know, perhaps 20 miles
to a find a pharmacy that

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would be able to provide
their medications. And but

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we're having that even in
urban city areas.

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>> For some, a visit to the
pharmacy is a quick step.

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Picking up 1 or 2
prescriptions. But for many

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patients, it's much more
than that.

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>> Your pharmacist a lot of
times will be a critical

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component of your medical
care team.

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>> Senate President Mary
Felzkowski authored

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legislation trying to help
local pharmacies keep their

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doors open.
>> We saw our small,

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independent pharmacy
starting to go out of

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business in rural Wisconsin.
When it may take months for

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a patient to get a clinic
visit. Pharmacists say they

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bridge that gap. Available
for anyone to walk in and

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ask questions at any time.
And prevention leads to

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healthcare savings.
>> For patients with asthma.

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We did a study with the
Pharmacy Society of

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Wisconsin and showed that
when they sat down with a

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pharmacist on two 30 minute
interventions, that they

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reduced the number of ER
visits, the number of

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hospitalizations. These
things are making a

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difference in overall
reducing health care dollars

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spent.
>> Like with most retail

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stores, it'd be reasonable
to assume that internet

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sales are putting pharmacies
out of business. And while

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mail order and online
retailer giants like Amazon

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do compete with on site
service advocates, diagnose

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a much deeper and chronic
issue.

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>> PBMs pharmacy benefit
managers have been around

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for a very long time.
>> Pharmacy benefit managers

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or PBMs act as middlemen
between drug manufacturers,

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wholesalers, providers,
insurance companies and

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pharmacies.
>> And they've monopolized

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and they've gotten in
between prescribers and the

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delivery of drugs, driving
up the cost of drugs instead

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of lowering them.
>> The three largest PBM

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companies accounted for 80%
of prescription claims last

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year.
>> They'll claim that they

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negotiate with drug
manufacturers and

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prescription drug costs.
However, despite these

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claims, PBMs regularly
inflate what patients pay

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and force pharmacies to
operate a loss.

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>> It's become very
powerful, and independent

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pharmacies like myself have
no negotiating power

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anymore. With these PBMs.
>> The impact of PBMs that

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PBMs are having on rural
pharmacy is staggering.

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>> The legislation takes aim
at a number of their

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practices, including not
allowing patients to fill

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prescriptions at certain
pharmacies.

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>> PBMs dictate where
prescriptions can be filled.

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>> Punitive audits against
pharmacists who inform

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patients of lower cost
options.

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>> What to charge a patient.
>> And perhaps the biggest

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of all for pharmacies.
>> What they will reimburse

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a pharmacy.
>> Reimbursing the price of

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medications below cost.
>> And when they'll pay the

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pharmacy.
>> Forcing them to take

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losses. At a Senate health
committee hearing, numerous

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local pharmacies attested to
this issue.

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>> My pharmacy is currently
operating in the red right

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now solely due to PBM
reimbursement rate margins

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estimated to PBMs have
increased by 46%, and during

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the same time, margins to
pharmacies have decreased by

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47%.
>> The contracts have become

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basically take it or leave
it. They've continued to

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erode year after year after
year, and it's estimated

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that independent pharmacies,
depending on your particular

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location in the country, can
have anywhere from 20 to 40%

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of their claims are actually
reimbursed below cost.

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>> But not all health
industry experts agree.

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>> We believe all these
provisions will be

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associated with increased
costs to health plans and

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sponsors.
the bill, such as health

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insurers, say it will
increase prices for health

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plans. Employers and
patients. The exorbitant

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cost of drugs, they say,
begins with the drug

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manufacturers.
>> Instead of taking away

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the few tools that health
plans and employers use to

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address ever increasing drug
prices, the legislature

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should focus on fixing the
market distortion caused by

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drug manufacturer pricing
schemes.

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hard on showing them through
data from other states that

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have allowed that have the
same legislation, where it's

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actually lowered the cost of
health care.

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>> Whatever the cause, the
impact on the patient is

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real, like the ability to
obtain diabetes medications.

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>> GLP ones, those. Some
pharmacies are just choosing

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not to carry them because
they get reimbursed below

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their cost.
>> Or having your insurance

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accepted.
choosing not to carry

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particular plans because of
the poor reimbursement.

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>> Every day in my pharmacy,
I witness patients facing

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exorbitant co-pays,
sometimes exceeding $500 for

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medications they cannot
afford. These patients are

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confused. They're
overwhelmed, and they're

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forced into impossible
decisions about their

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health.
>> For a patient having to

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fill prescriptions at
multiple pharmacies, the

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consequences can cost them
their lives.

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>> Recently, when
learned that they had a

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duplicate prescription that
was at another pharmacy from

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a different doctor. If they
had gone home and taken

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both, they would have needed
emergency care and it could

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have been fatal.
>> From the extremes of the

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pandemic to the work they do
every day, independent

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pharmacists say their
commitment is to their

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community.
>> What happens if PBMs

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continue to drive us out of
business? Who will step up

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during this crisis? Who's
going to be doing seven day

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a week testing? Who's going
to deliver meds late at

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night for a hospice patient
who's going to get a call at

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2 a.m? I just got that last
week. It won't be a mail

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order pharmacy in another
state that's doing that.

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>> Being able to provide
that service to patients and

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to be part of making sure
that they are taken care of,

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is really what we want to
ultimately do.

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>> Reporting from green Bay,
>> Reporting from green Bay,