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Local pharmacies are historically central to community life and have been for generations. If they offered a soda fountain counter with round swivel stools, so much the better.
Today’s family pharmacists throughout the area, however, are struggling under an oppressive pharmaceutical insurance middleman system that strips away profit from their prescription counter.
Beginning in the 1960s, Pharmacy Benefits Managers (PBMs) came upon the scene to process drug claims for insurance companies. By the 1970s they were serving as middlemen between manufacturers, insurance companies and pharmacies, adjudicating prices.
Today, PBMs not only adjudicate claims, but now they develop and manage pharmacy networks, determine the list of drugs to be covered by insurance, set co-pay amounts and serve to channel the patient to a particular choice of pharmacy.
According to the Pharmacists Society of the State of New York (PSSNY), PBMs can own their own pharmacies, retail and mail order, and profit from sales and services. The work of the PSSNY is to propagate and protect community pharmacies.
The effect of this progression as PBMs have become “invisible middlemen” has been devastating to local family-owned pharmacies in area towns in New York and Connecticut, endangering their existence and the invaluable service they provide to their patients and the communities they serve.
Today, the three largest PBMs control nearly 80% of the prescription benefits market share in the U.S., according to the PSSNY.
“We are so lucky to have this pharmacy. It’s a blessing,” said Pine Plains resident Ann Noone, a regular customer of the Pine Plains Pharmacy, commenting on Monday, April 8 about the local business and its pharmacist. “He’s done a lot for this town.”
Pharmacist at the Pine Plains Pharmacy since 1989, and owner of the historic corner drug store since 2006, Nasir Mahmood has witnessed the financial squeeze on area pharmacies with some forced to close their doors, victims of the PBM system.
It is the PBMs that pre-determine how much each drug covered under the plan should cost, and this is the amount it reimburses all pharmacies except the large-chain ones they own. Often the reimbursement rates are well below the cost of the drug, putting pharmacies in the position of having to fill a prescription at a loss.
“We cannot wait for PBM reform,” said Mahmood on Wednesday, March 27, describing the current tenuous status of bi-partisan federal legislation awaiting vote in Washington, D.C.
Having served as president of the PSSNY for two years in 2008-09 and having finished a two-year term as chairman of the PSSNY Board in March, Mahmood now continues as a member of that board. He also serves on the National Legislative Committee within the National Community Pharmacists Association (NCPA) working with other pharmacists’ professional organizations promoting new legislation to place limits on PBMs and create an equitable structure of reform and accountability.
Bipartisan bills have passed out of committee and are awaiting floor vote that would provide strict regulation and transparency to the work of the PBMs, improve patient access and lower costs, Mahmood said. The NCPA has achieved some recent success in the long process of bringing bills to the floor for a vote.
A series of Senate and House bills received bipartisan support and convincing vote margins as they emerged from committees. With passage, the various pieces of legislation would bring lower drug costs, greater transparency in the process, require the Centers for Medicare and Medicaid Services (CMS) to define their contract terms, and require PBMs to operate with greater transparency.
The legislation was attached to the government funding package that was passed in late March to avoid a government shutdown, but Mahmood said that at the last minute the PBM bills were stripped out of the package.
Continuing their commitment to PBM reform, however, Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) pledged to press on with efforts to enact the legislation before the end of this congressional year.
The NCPA further reported that on Friday, March 22, a bipartisan group of 21 senators and 51 house representatives signed a letter to their respective leadership, asking for immediate action on PBM reform measures.
Advocacy groups are actively pursuing passage of the legislation having arranged a conference drawing pharmacists from across the U.S. to the national headquarters of the NCPA in Alexandria, Virginia, for a two-day meeting to begin on Wednesday, April 17.
“We’ve come a long way with continued advocacy year after year,” Mahmood said, contemplating his participation in the upcoming meeting. Senators and representatives will be reporting to the conference and encouraging continued advocacy strategies to promote passage of the bipartisan PBM legislation.
One bill would bring transparency to Medicaid drug pricing with annual savings of $1 billion. Another would remove PBMs from negotiating CMS services, and the third would provide for greater transparency, oversight and enforcement through the Federal Trade Commission (FTC).
Independent pharmacies throughout the area have expressed their concern about the issue and joined in the hope that the current efforts toward passing legislation will be successful.
Meanwhile, local and area pharmacists remain in the balance, squeezed by the PBM system and locked out of the price negotiation process. During an interview, Mahmood noted that there is not one independent community pharmacy left open in Columbia County.
“It’s not fair,” he said.
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County challenges even-year voting
Apr 17, 2024
North East Town Hall
Photo by John Coston
POUGHKEEPSIE — The Dutchess County Legislature passed a resolution authorizing the use of $100,000 of taxpayer funds to challenge a state Senate bill designed to increase voter turnout and save money in local elections by moving some local elections to even-numbered years.
On Tuesday, April 9, the county legislature voted for the resolution 14-7, along party lines, with the Republican majority voting for the appropriation. Proponents of the appropriation claim that the state’s action is a violation of home rule.
The law in question
Governor Kathy Hochul signed senate bill S3505B, which moves certain local elections to even numbered years, into law last December. It was the latest version of a bill that has been in the works since January 2023; earlier versions have been brought in nearly every session since at least 2013.
“Aligning local elections with general elections has been proven to be one of the single most effective ways to not only reduce the turnout gaps by race and age, but also to improve governance outcomes so that local governments are better reflective of the will of their constituents,” said Harvard Law School’s Election Law Clinic in a statement applauding the measure.
At the signing, Hochul noted that the statewide turnout in the 2020 election was 64% of registered voters, compared to 25% for local elections in 2021.
2020 was a presidential election, so a comparison to the state, local and gubernatorial elections of 2022, which had a 43% turnout, is also worth noting — as is the 18% percent statewide voter turnout in 2023 local elections.
“When elections are held in odd-numbered years, away from the traditional election cycle that voters are most familiar with, the cost of participating in the democratic process is increased, particularly for voters who may have a difficult time arranging for time off of work and traveling to their polling site,” explained the Governor’s office in a statement. “By consolidating more elections in even-numbered years when most voters are already planning to participate in an election, this change will increase voter participation in important local races.”
In Dutchess County, voter turnout was 78% in 2020, but fell to 34% for elections held in 2021 and 2023. In addition to dramatically increasing voter turnout for municipal and local elections, it would also save local taxpayers money, proponents have noted.
At the signing, Gov. Hochul underscored the point, saying, “Every eligible New Yorker deserves the right to participate in the democratic process without unnecessary barriers. By signing this legislation, we are taking a significant step towards expanding access to the ballot box and promoting a more inclusive democracy.”
The law consolidates all elections into even years, though legislators are working on an amendment to the state constitution that would make that possible. Until then, all local elections in New York City and all elections for city and village positions, school board seats, judges, county sheriffs, clerks and district attorneys will continue to take place on odd-numbered years.
Dutchess County’s challenge
By moving certain elections to even-numbered years, the new law amended the town law, the village law, the county law, and the municipal home rule law of several constituencies, including the Dutchess County charter, which specifically states that local elections must take place during odd-numbered years.
“The charter, which was enacted by the residents of the county, specifically states that elections for county offices are to be held in odd-numbered years,” said Majority Leader Deirdre Houston (R-District 25), who represents Amenia, Millbrook, Washington and Pleasant Valley. “New York State decided to unilaterally change the mode of our elections without so much as consulting the voters of Dutchess County.”
“I made it clear the day I became chairman that we would fight this unconstitutional power grab with any available measure,” said Dutchess County Legislature Chairman Will Truitt (R-Hyde Park). “Every member of the legislature swore an oath at our Organizational Meeting in January to uphold the county charter. We simply cannot sit idly by as the state attempts to circumvent the very charter that we all swore to uphold.”
Other proponents of the lawsuit have said that the new law would actually cost more money, requiring the hiring of more election staff on even-numbered years, rather than saving money longterm by decreasing staffing and other needs on odd-numbered years. They have also voiced concerns that if local elections are held in even-numbered years, national issues and national partisanship will overshadow local concerns. In general, however, statements explaining the suit have mostly adhered to concerns about “home rule.”
Describing the changes as “monumental,” Houston said, “in my view, [the new law] represents a blatant disregard for the people of Dutchess County and their desire for local control.”
Proponents of the law have accused the county’s Republican legislators of being politically motivated, and say that they are acting to protect the party’s edge in local elections, which could be at risk if voter turnout increased.
“This is a waste of money. The County budget is extremely tight due to years of budget mismanagement, and there are more important needs in our community that must be addressed first,” said Chris Drago (D - District 19), who represents North East, Stanford, Pine Plains, Milan and Red Hook.
“We need to be investing in vital needs for our community: EMS, transportation, mental health and keeping Cornell Cooperative Extension’s door open so they can continue to support agriculture, and environmental and Youth Services for our community.”
He continued: “This is the first major issue that this legislative body has taken up since we took office, and it’s about limiting voter turnout.” He added, “It’s embarrassing.”
Onondaga and Nassau Counties have also filed challenges, listing similar concerns; the Oneida County legislature has also authorized a potential lawsuit. All three legislatures have a Republican majority.
Dutchess County’s budget appropriation of $100,000 is expected to be enacted by County Executive Sue Serino.
If the law survives challenges by Dutchess and other counties, which it is expected to do, officials elected after Jan. 1, 2025 will serve shortened terms.
Dutchess County legislators, who typically serve two-year terms and were last elected in November, will run for re-election in 2025, but serve terms concluding in 2026. The next election for Dutchess County executive, normally a four-year position, would take place in 2027, then again in 2030.
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Breakfast with the Sheriff
Apr 17, 2024
Christine Bates
The pancake breakfast at American Legion Post 178 in Millerton on Sunday, April 14, a fundraiser for Sheriff Kirk Imperati, who is running for reelection, was packed with people and politicians from all over Dutchess County. It was organized by Bruce Flynn of Millerton. Left to right, Sheriff Imperati, Flynn and Undersheriff Jason Mark.
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