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Expression of TRPC4 after transfection

Pharmacy benefit managers work for insurers and employers, negotiating with drug companies to buy medications on their behalf. But one of the ways pharmacy benefit managers take in money is through a practice known as “spread pricing,” in which they charge more for medications than they pay the pharmacies.

It ultimately adds an incentive, pharmacists say, to underpay them. And the small pharmacist who doesn’t have deep pockets is particularly vulnerable, they say.

Owen Sullivan, a third-generation pharmacist, said that last year his pharmacy, Sullivan Drugs in Carlinville, lost money for the first time in 28 years. “That’s where a lot of (pharmacies) are,” Sullivan said. “They’re sitting on the edge going, ‘Man, I hope this gets fixed.’”

Amid national debates over the rising costs of drugs — and who’s to blame — pharmacy benefit managers have fallen under increasing scrutiny.

Some states, including West Virginia and Ohio, have already cut pharmacy benefit managers who engage in spread pricing out of their Medicaid managed care programs.

Pharmacy benefit managers, however, defend their work, saying they help keep drug costs low, including in Illinois’ Medicaid managed care program.

Benefit managers provide access to a broad range of medications at “a rate that is sustainable for the state budget while also fairly compensating pharmacies for services they provide,” said Scott Woods, a senior director of state affairs at the Pharmaceutical Care Management Association, a pharmacy benefit managers group. Spread pricing is just one option that clients, such as states or insurers, can choose as part of their contracts, they say.