Starting Wednesday (Oct. 1), independently owned pharmacies in Alabama will be reimbursed more money for some of the drugs they provide customers.
While advocates for the new pharmacy reimbursement law say consumers shouldn’t notice any changes at the register, one insurer says some customers could see their out-of-pocket costs increase.
Subscribe to The Alabama Baptist today!
SIGN UP for our weekly Highlights emails.
One of the most significant items of the 2025 legislative session, Senate Bill 252 says pharmacy benefit managers can’t reimburse independent pharmacies less than the amount paid by the Alabama Medicaid Agency. That currently includes the average cost of the drug and a $10.64 per-prescription dispensing fee.
Pharmacy benefit managers are third-party groups that negotiate drug prices for insurers and enter into contracts with pharmacies. While stores have not been underpaid on every prescription they sell, pharmacists for years have told lawmakers about losing hundreds of dollars, sometimes thousands, on a single prescription. They blamed low reimbursement rates as a primary reason for the shuttering of dozens of independent pharmacies in recent years.
Sen. Billy Beasley, D-Clayton, sponsored the bill in the Senate. He’s a retired pharmacist who once owned several stores.
“It’s personal for me, but it’s really personal for all the drugstore owners in Alabama,” Beasley told Alabama Daily News on Monday. “If you lose a drugstore in a small community, it affects the citizens of that community greatly.”
Beasley said the bill gives Alabamians “freedom of choice.”
“(Pharmacy benefit managers) can’t dictate where a patient has to go to get a prescription filled,” he said.
The bill also prohibits the practice of “spread pricing” where a benefit manager charges health plans more for drugs than they pay pharmacies.
What about chain pharmacies?
The new law doesn’t apply to chain pharmacies, Medicare recipients or those who buy their medications without insurance.
The law says PBMs can’t “increase a covered individual’s cost-sharing percentage or ratio at or after the point of sale by raising the deductible, copayment, or coinsurance, or by requiring any other out-of-pocket payment as a means to recoup the dispensing cost…”
Blue Cross and Blue Shield of Alabama uses Prime Therapeutics as its PBM.
“On Oct. 1, customers may see changes to the amount they owe when picking up prescriptions at a community pharmacy,” BCBS said in a statement to ADN on Monday.
The insurer said copay amounts are not changing, nor is the way copay amounts and out-of-pocket costs are applied. Health plans have always required customers to pay the lesser amount of the cost of the drug, including the dispensing fee, or the designated copay.
For example, if a customer’s copay is up to $15 and their prescription in September cost them $8, starting Wednesday, the cost of that drug and dispensing fee is now more than $18. The customer would pay the $15 copay, but not more.
It’s unclear how many people might see higher costs, and it will depend on plans and medications.
EDITOR’S NOTE — This story was written by Mary Sell and originally published by Alabama Daily News.
Share with others: