Bill to help small pharmacies passes state senate

Neville's bill would prohibit third-party middlemen from collecting certain fees from pharmacies and pharmacists

Hannah Grover
Pharmacist Ashley Seyfarth places a bottle back on the shelf, Monday at Kare Drug in Bloomfield.
  • Neville's bill would prohibit pharmacy benefits managers from charging pharmacies fees for claim processing and adjudication
  • A Bloomfield pharmacist says these fees can cost small pharmacies an average of $2,000 a month
  • A spokesman for Express Scripts, a benefit manager, says the fees support services provided to the pharmacies

FARMINGTON — A bill sponsored by Sen. Steve Neville, R-Farmington, aims to help small pharmacies by eliminating fees they currently pay to middlemen.

"The small pharmacies around the state are having a hard time surviving," Neville said when reached by phone today.

Neville worked with the New Mexico Pharmacy Business Council to draft the bill, which would prohibit pharmacy benefits managers from charging the pharmacies fees for claim processing and adjudication. Pharmacy benefits manager are third-party middlemen of prescription drug programs. These middle men check patient eligibility, administer plan benefits and negotiate costs between the pharmacies and the insurers. Each insurance company contracts with a pharmacy benefits manager.

The pharmacy at Kare Drugs is pictured on Monday in Bloomfield.

The bill passed the New Mexico Senate last week and is currently in the House Business and Industry Committee. Neville said it has been well received and he hopes it will pass the House before the end of the legislative session.

Ashley Seyfarth, a board member of the New Mexico Pharmacy Business Council and a pharmacist at Kare Drug, said the pharmacy benefits managers are hired by insurance companies and charge pharmacies fees for processing the claims.

She said they essentially charge the pharmacy so that the pharmacy can be paid for dispensing a drug. The New Mexico Pharmacy Business Council states these fees can range from 2 cents to $20 per claim. Each pharmacy handles hundreds of prescription drug orders a day. Seyfarth said pharmacies pay about $2,000 a month each.

Brian Henry, vice president of corporate communication at Express Scripts, said in an email statement these fees are normal and nominal and ensure convenient access to pharmacies. Express Scripts is one of three major pharmacy benefits management companies in the country.

Neville said a $1,000 to $3,000 payment can be the difference "between survival and folding up the tent and going home" for small pharmacies.

He said pharmacies like Kare Drug in Aztec and Bloomfield provide valuable pharmacy care for rural areas. Aztec has two pharmacies — Kare Drug and a pharmacy inside Safeway. Bloomfield has only one pharmacy, Kare Drug.

Pharmacy Technician Trinka Colate works on a filling a prescription, Monday at Kare Drug in Bloomfield.

Henry said the fees that the Express Scripts charge help ensure prescriptions are filled accurately and quickly. He said the fees are not unique and compared them to fees used in the credit card industry to reduce risk of consumer fraud and for retailers to receive immediate payment for purchases.

"Additionally, these fees also support maintaining help lines, benefit manuals and other services provided to the pharmacy by the (pharmacy benefits manager)," Henry said.

Hannah Grover covers government for The Daily Times. She can be reached at 505-564-4652.