By Morgan Chilson, Kansas Reflector
TOPEKA — White medical coats dotted the Capitol rotunda last week when hundreds of pharmacists advocated for industry pricing transparency that would help them stop filling a large percentage of prescriptions for free.
Will Anderson, a Lawrence pharmacist, carried a large three-ring binder with color-coded pages to show a full year of prescriptions filled at his business, Orchards Drug. About 20% of the dark red pages denoted about 26,000 prescriptions filled for under what it cost to purchase the medication, he said.
Another 53% of the pages indicated prescriptions filled for pennies over the medication’s cost, Anderson said. In Kansas, the average cost for a pharmacy that’s not part of a chain to fill a prescription is $15.85 per prescription, which includes salaries, overhead and base expenses, he said.
In a small sliver at the back of the binder are white pages that denote 17% of prescriptions that pay above the medicine cost and enough to cover overhead, Anderson said.
“So 83% of the time when we fill a prescription for someone, when they walk in our door and we’re trying to help them, we’re getting paid below cost,” Anderson said. “The only way pharmacies can survive and still exist is if the 17% makes up for the 83%, and it doesn’t.”
Anderson said pharmacies started offering vaccines and other services so they could add to their revenue streams. His pharmacy sells nylon Snoopy bags, he said, laughing.
Anderson and others at the Capitol hope lawmakers pass Senate Bill 360 this year as a first step to helping local pharmacies. The Senate Committee on Financial Institutions and Insurance passed the bill last week, but it still needs approval from the full Senate and House.
The bill addresses the industry’s financial challenges by creating more transparency in the process between pharmacies and pharmacy benefit managers, or PBMs, said pharmacist Mike Ryan, who is the pharmacy practice coordinator for Dillons.
A PBM operates between the pharmacy and the drug company, allowing pharmacists to process claims immediately and fill prescriptions, Ryan said.
“They serve a vital role,” he said. “The problem is they became monopolistic and vertically integrated, which is costing the system a ton of money.”
Ryan said another problem is spread pricing, which means PBMs pay pharmacies one amount for a drug and charge the state more, keeping the difference.
“They own their own pharmacies, their own PBM insurance companies, all the way down,” he said. “They will steer patients to their own pharmacies and then reimburse themselves more than they reimburse other pharmacies.”
Ryan said the bill pharmacists are advocating for isn’t unusual and similar legislation has passed in multiple states. In 2022, Ohio moved its Medicaid system to a single PBM with transparent pricing.
The state saw a savings of more than $140 million, Ryan said.
Federal legislation demanding more PBM transparency for Medicare Part D patients became law last week as part of the Consolidated Appropriations Act of 2026, according to the American Journal of Managed Care. The law doesn’t address transparency regarding how drug prices are set in private insurance.
SB 360 creates the Kansas Consumer Prescription Protection and Accountability Act, which would give the insurance commissioner more oversight and authority over PBMs.
The bill requires PBMs to charge a health benefit plan the same price as a pharmacy for a prescription drug, utilize the most recently published monthly National Average Drug Acquisition Cost as a point of reference, and reimburse pharmacies at an amount not less than the NADAC. The bill also sets the professional dispensing fee at $10.50.
Ryan said the bill would help pharmacies that don’t have negotiating power since three PBMs control more than 80% of all of the claims that go through pharmacies for the whole country.
“This is such a hard bill. This is a hard industry to regulate. It’s so complicated and so opaque because they have made it that way,” Anderson said. “This could be a multiyear effort. Drug costs are so expensive in our country. I am exhausted, but we’re going to keep fighting.”
