Lawmaker Backs Bill To Ensure Pharmacies Can Keep Doors Open In Face Of Escalating Costs

ROCKVILLE CENTRE, NY. — State Assemblymember Judy Griffin was in Rockville Centre Tuesday, flanked by a group of pharmacists who had turned out to a press conference in support of the Patient Access to Pharmacy Act.

Griffin is one of more than 50 members of the Assembly co-sponsoring the bill, which seeks to ensure pharmacists receive enough reimbursement from providers to keep their doors open.

The press conference came as an effort to get the bill passed in the 2026 legislative session, a goal Griffin told Patch she feels optimistic about reaching thanks to bipartisan support. If passed, the bill would require that pharmacists receive at least the national average drug acquisition cost (NADAC) when filling prescriptions, and would establish a minimum dispensing fee for them to be paid by providers.

In the eyes of Howard Jacobson, owner and operator of Rockville Centre Pharmacy, the bill comes at a time when pharmacists across the state are feeling the squeeze.

“It's not uncommon to see zero dispensing fee, or a 25-cent dispensing fee [for filling a prescription]. And that's supposed to pay me for everything that we do, from paying the rent, to the electric, to having it delivered to a customer that doesn't go out of the house, to the vial that we put the medicine in, to paying for security, for insurance. 25 cents, [or] zero dispensing fee,” Jacobson said. “There are sometimes prescriptions where I get, total for a month's supply of a patient's medicines, 29 cents. 29 cents a month. The medicine costs 20 cents. The cap costs four cents. The label costs four cents.”

On those 29-cent reimbursements, Jacobson said, the cost of medicine, a label and a cap alone pushes his profit margin to just one-cent.

“It's at the existential point now where we cannot afford to give any more money up,” Jacobson added. “I can't afford to give up what I'm giving up right now.”

The financial squeeze, Jacobson said, comes primarily from pressures imposed by Pharmacy Benefit Managers (PBMs). According to the longtime pharmacist, PBMs initially played a clerical role in the healthcare system, verifying eligibility, adjudicating claims and processing payouts to pharmacists who had filled prescriptions. In an interview with Patch, Jacobson compared them to, “the Mastercard or Visa of pharmacy.”

CVS attributes PBMs with, "Designing and administering cost-effective prescription drug plans that meet the financial and health care needs of our customers and members," calling them "one of the few parts of the prescription drug supply chain specifically dedicated to lowering costs."

The National Association of Insurance Commissioners noted that, as of 2022, CVS's PBM, CVS CareMark, was one of the three largest PBMs in the United States. Those three PBMS (CVS CareMark, Express Scripts and OptumRx) collectively processed 79 percent of all prescription drug claims in the country, the NAIC said.

"Their primary role is to manage prescription drug benefits on behalf of health insurers, employers, unions, and government programs," NAIC materials read. "Essentially, PBMs act as middlemen between insurance plans, drug manufacturers, and pharmacies, working to control drug spending, process prescription claims, and determine which medications are covered by insurance plans."

Representatives from CVS CareMark, Optum and ExpressScripts did not immediately respond to requests for comment on the legislation.

For a time, Jacobson said he and other pharmacists had positive experiences with PBMs.

“They were invented to serve a purpose, and truth be told, with a lot of pharmacists, me included, we were happy when we were able to deal with insurance companies by a central clearing house, which the PBMs were,” Jacobson told Patch. "They just made the electronic age a lot more easy to deal with."

As insurance companies have expanded their offerings, however, Jacobson said pharmacy benefit managers have taken on more of a financial role. In an interview with Patch, Griffin said this change has led to PBMs putting hard math in front of pharmacies, squeezing the amount they're reimbursed and making certain prescriptions a money-loser.

"So every time they have a prescription that they fill, they’ll lose, sometimes, $200 on a prescription, $100 on a prescription,” Griffin said. “So, eventually, if an independent pharmacy can’t absorb all of these losses, they end up closing their doors. So that’s a big issue for the pharmacy itself, and they’re small businesses throughout most towns.”

One representative from Griffin’s office compared pharmacy to a traditional retail environment, noting that the path money takes through pharmaceuticals looks a little bit different.

“Most people understand the way the typical retail business works, you go to a grocery store to get a gallon of milk. The supermarket will buy gallons and gallons of milk, wholesale, and they may pay a dollar a gallon, and at the point of sale, if they're charging $4 a gallon, they recoup that dollar, and then make $3 profit right there,” the representative said. “Pharmacy is one of these businesses that works differently. The debt recouped at the point of sale is a very small portion, in many cases, of the total of the drug [cost], and most of what pharmacists make is through after the reimbursement [from providers]…The money that gets reimbursed passes through the hands of PBMs. That's why they're called the middlemen. The insurers pass that money through the hands of PBMs before it gets to pharmacies, and in that process of passing it through their hands, the PBMs, there's a total lack of transparency that allows them to pocket a lot of that money.”

That lack of transparency, the representative said, creates some hard calculus for pharmacies.

“The insurer may be giving the money, thinking that drug costs ‘X’ number of dollars per-prescription, but only a fraction of that actually ends up in the hands of a pharmacy,” the representative said. “And in many cases, this is resulting in pharmacies, particularly on brand-name drugs, actually losing money. And so they’re making less money, [and] getting reimbursed less money than they actually paid to stock the drug.”

From Griffin’s point of view, the financial hardship being faced by small pharmaceutical businesses across the state constituted a problem that legislators could solve.

“I love common-sense legislation that addresses a problem, doesn’t go too far, just addresses a problem and solves a major problem that our independent pharmacies have across the state,” Griffin said. “This is a way it can be addressed, and we can help resolve this issue.”

In Jacobson’s eyes, the plight of the local pharmacy isn’t just a business issue. In the communities the local pharmacy serves, Jacobson said, it’s just as much an issue of community and public health.

“We provide. We don't just give a drug out and through a window and walk away. We are members of our communities, we hire people that live in the communities, we've been taking care of families. I'm not just a face, I'm a name."

He added: "We know the people we provide health care…We know the medications that patients are taking. We know even their family histories,” Jacobson said. “We know we were the first line of defense when it comes to our communities, when it comes to chronically ill people, when it comes even to low income people, these folks rely on the local independent pharmacists. If they go into a busy chain pharmacy, those pharmacies are filling a couple-thousand prescriptions. The pharmacist is running around, wants to tear their hair out. Here, when they come in, we step out from behind the counter. We know the person, and even if we don't know them, we say, ‘Oh, that rash looks like ringworm. For that, why don't you try this cream? If it doesn't help, in a week, go to a dermatologist.' It's multiple reasons why we are important in the whole healthcare system.”

Griffin added that her office is located next to an independent pharmacy, saying that she sees the benefit these small businesses provide to communities.

“They really benefit people who have to regularly get medicine. Every month, they have to fill prescriptions, or they have questions. These local pharmacists can answer the questions, they set up deliveries to people, they know who their patients are,” Griffin said. “When we were in Howard Jacobson’s pharmacy today, a number of customers came in and he knew them by name. That’s a big difference in the treatment you get, when you’re known by name.”

Jacobson has spent almost 40 years as a pharmacist in Rockville Centre. When asked what kept him going through the complicated financial landscape facing pharmacies today, the pharmacist cited a college professor of his who called pharmacy, "an art and a science."

"I believe in the science of pharmacy and the art, which is the dealing with people on a one to one basis in many aspects of their health care, not just giving out a bill and saying, 'take it twice a day.' That that's the artistic part of being a pharmacist," Jacobson said. "And I believe that pharmacy is a very noble profession, and I don't want to see independent pharmacy go the way of the small independent hardware store or the small independent bakery...I think that people should have the opportunity to use an independent pharmacy, if that's what they want to do."