My name is Al Roberts and I co-own Remington Drug Company with Travis Hale. While our county is becoming less rural, we still struggle with access to healthcare services for many of our patients. Our patients struggle at times to get appointments with their medical providers, find transportation (affordable) to their provider appointments, pay for their prescriptions, and locate a pharmacy that can meet their needs. Our pharmacy offers delivery (free within limits and at a reasonable charge outside that area), 24 hours/after hours services, medication synchronization (fill all prescriptions for 1 pick-up/delivery per month), consultation on medications, and immunization services. A large portion of our patients are seniors (Medicare) or on a state supported program (Medicaid). We are one of three independent pharmacies in our county. We have one in the northern end, one in Warrenton (county seat) which is a specialty, compounding pharmacy and does not accept many insurance plans, and our pharmacy in the southern end of Fauquier County. Many, but not all of the chain/big box pharmacies, do not accept some of the Medicaid prescription plans creating a problem for that patient population when they seek prescription services. To be sure healthcare is a business , but for pharmacies both big and small to continue to provide access and expanded services adequate reimbursements are a must. Currently only 1 MCO is providing a dispensing fee anywhere close to a reasonable fee. None of those MCOs have a dispensing fee anywhere close to the Fee-for-Service Medicaid fee of $10.65. There are at least 5 counties in the Commonwealth without A PHARMACY and a dozen or so counties with ONLY 1 PHARMACY. Coincidently, Rappahannock County, which borders Fauquier County does not have a single pharmacy. With the projected shortages in medical providers over the next decade, pharmacy is a very capable partner (look what pharmacy accomplished during COVID-19) to help bridge this gap and access to care. That is if we are still in business. I respectfully ask that this committee look at this problem and develop a plan that is a win for the Commonwealth, the pharmacy, and most importantly the patient. Respectfully, Al Roberts

My name is Jeremy Counts, Owner of Counts Family Pharmacy in Blacksburg, VA and executive board member of Pharmacists United for Truth and Transparency. First, it needs to be noted that pharmacy closure data is notoriously difficult to obtain. Most independent pharmacies do not bother to deactivate their NCPDP data after closure. Any “study” that cites NCPDP data is severely limited. The only accurate pharmacy closure data must be obtained through the board of pharmacy. Working with lawmakers and pharmacists, I reached out to the board of pharmacy and received said data. There are currently 1277 community pharmacies identified in the data, a 14% decrease from ten years ago. Community pharmacies are failing at nearly twice the rate they are opening Most stores opening are independent, but those also account for a disproportionate amount of closures. Pharmacists are not only the most accessible healthcare professional, we are also the only healthcare access that many patients have in their communities. Having access to a community pharmacies saves the system countless dollars by not only increasing medication adherence, but also keeping non-emergent problems out of the emergency room Clinics alone cannot community needs. Even in some of the smallest towns and counties, there are pharmacies moving hundreds of prescriptions a day and taking care of numerous problems the system doesn’t even see. I don’t have time to touch on this today, but 340b is not the answer. It is an incredibly abused system with 75% of 340B pharmacies owned by an insurance conglomerate, Walgreens, or Walmart. APCI’s Greg Reybold recently released a new white paper showing how much savings moving plans to an established pricing model would create. Going to a model of NADAC plus the state dispensing fee plus 2% would generate massive savings for plans sponsors by preventing price gouging of chain, specialty, and PBM affiliated pharmacies It would also ensure a fair reimbursement for independent pharmacies that are often the only access many communities have Even more savings can be generated by realigning state medicaid incentives like we have seen in states like West Virginia and Kentucky, who have generated tens to hundreds of millions of dollars in savings. These realignments have worked because it eliminates MCO and PBM gamesmanship of the system, like we have seen in Oregon and Florida Medicaid. If we want our rural communities to keep healthcare access, it is imperative that we establish standardized reimbursement rates and make sure dispensing fees are passed along to pharmacies instead of sucked up by middlemen. We can do all of this while saving the Commonwealth millions every year. I am currently working on bill language with lawmakers and leading experts in the field. This law will: Save pharmacies from closing and plan sponsors from being gouged by basing reimbursement based on NADAC,’ a real market index, that provides a fair, state established dispensing fee Prohibit abusive PBM practices that allow them to game the system Bring down costs for patients and plans alike by eliminating skimming And save the commonwealth a fortune by re-aligning incentives in DMAS. The savings and improvements to the system would lead the nation and ensure not only critical access is saved, but even expanded. I am available for any questions at your convenience.