Pharmacist offers alternative as prescription drug costs drive Americans to Canada
As a new federal rule threatens to make it harder for Americans to obtain lower-cost prescription medications from Canada, a Beaver County pharmacist said his business offers an alternative by cutting out the middlemen he believes drive up drug prices.
Brandon Antinopoulos, owner and pharmacist at ForwardRX Pharmacy in Beaver, uses a cost-plus pricing model that he said allows customers to see exactly how their medications are priced.
"We don't have any insurance contracts," said Antinopoulos. "Not having any contracts allows us to be completely transparent with folks in the way we price our medications."
ForwardRX does not contract with pharmacy benefit managers, commonly known as PBMs. These companies act as intermediaries between health insurers, pharmacies and drug manufacturers.
Antinopoulos said his pharmacy instead adds a straightforward markup to the cost of each medication.
"Whatever the cost of the medication is for us to get, we do a simple, transparent markup, and that is the price," said Antinopoulos.
He described the approach as a return to a simpler model of pharmacy pricing, before more Americans began looking outside the country for affordable prescriptions. The discussion comes as a change to U.S. Customs and Border Protection rules is expected to affect the handling of prescription medications imported for personal use.
Some Americans have relied on Canadian pharmacies to obtain medications at significantly lower prices than those available in the United States.
The upcoming change, scheduled to take effect Oct. 22, is expected to end the use of enforcement discretion for certain packages of medication intended for personal use, potentially making it more difficult for patients to receive prescriptions from abroad.
Victoria Elliott, CEO of the Pennsylvania Pharmacists Association, said pharmacists have a responsibility to ensure patients receive safe medications through appropriate regulatory channels.
"At the end of the day, pharmacists are responsible for the safety of their patients," said Elliott. "So, if we are going outside of those regulatory parameters, we can't guarantee patient safety."
Elliott said she also hopes the change prompts a broader conversation about why Americans are turning to other countries to afford their prescriptions.
"This may just be the pressure we need to relieve some of that, kind of right that ship, talk about vertical integration, and make sure this is not hitting the patient at the counter for sure," said Elliott.
One issue at the center of that conversation is vertical integration, in which companies operate multiple parts of the healthcare system. The Federal Trade Commission has reported that the three largest pharmacy benefit managers process nearly 80% of prescriptions filled in the U.S.
The companies behind these PBMs also have ties to health insurance plans and retail pharmacies, raising questions about how the structure of the industry affects competition and what patients ultimately pay.
Critics argue that the concentration of power among these companies can make prescription drug pricing less transparent and leave patients facing higher costs.
Antinopoulos believes his pharmacy's cost-plus approach offers a different model by avoiding contracts with PBMs and giving customers a clearer picture of medication costs.
As patients face uncertainty about access to cheaper medications from Canada, he and other pharmacists said the larger question remains: Why do so many Americans struggle to afford prescription drugs, even when they have health insurance?
