In 2020, the food industry has sustained, bolstered and at times shifted operations to ensure Americans have access to safe, nutritious and affordable foods and supplies in high demand, while supermarket pharmacies have continued to serve as a bridge between communities and other providers, offering patients immediate care that is close and convenient to home.

Peter Matz

We witnessed during this unprecedented year how important supermarket pharmacists in particular are to protecting public health and providing services that support patient and grocery shoppers’ health and well-being.

As an industry deemed essential to the nation’s COVID-19 response by the federal government, our members have been and continue to be a critical component of ensuring the availability of food, supplies, pharmacy and health care services in communities across this nation, beginning in the initial days of the pandemic.

FMI – The Food Industry Association member companies operate roughly 12,000 supermarket pharmacies nationwide, with pharmacists providing in-depth patient counseling and comprehensive immunization services. They offer the ability for consumers to receive vaccinations at the same location where they already purchase food and other essentials, which is not only a convenience; it is safer and reduces the risk of exposure in the midst of a pandemic.

We have worked closely with federal agencies and Congress to both elevate the critical role of supermarket pharmacists and pharmacy technicians and to highlight the importance of ensuring the health of our industry’s essential workforce, who together touch the lives of more than 100 million U.S. households on a weekly basis.

Case in point, FMI has advocated for pharmacists and pharmacy technicians to be among those who are given the highest priority for receiving COVID-19 vaccinations, along with other high-risk, frontline health care providers. During this pandemic, pharmacists and pharmacy technicians have been on the front lines every day serving patients as health care professionals deemed critical to societal continuity as part of the Department of Homeland Security’s Guidance on the Essential Critical Infrastructure Workforce. Pharmacists are among the country’s most accessible health care providers, with close to 90% of the U.S. population living within five miles of a pharmacy, according to the Centers for Disease Control and Prevention (CDC).

Additionally, given the success to date of pharmacists administering vaccines, such as the annual flu vaccine, serving as knowledgeable and accessible immunization providers within their communities and collaborating with public health and other providers, a successful COVID-19 vaccination plan should actively involve pharmacists. With the appropriate resources, pharmacists will dramatically expand access to COVID-19 vaccinations and rapidly advance our nation’s immunization program, similar to the role many pharmacists played with the H1N1 vaccination. Our industry looks forward to playing a key role in helping the country move forward as the vaccination efforts begin.

Moreover, leveraging phar­macy-based immunizations is imperative to reaching a greater number of Americans in neighborhoods nationwide, including communities disproportionately impacted by the virus. With that in mind, FMI appreciated the recent CDC guidance that authorized pharmacists to provide COVID-19 vaccines as well as the partnerships between the federal government and pharmacies to maximize access to COVID-19 vaccines for all Americans.

Therefore, we were pleased that the National Academies of Sciences’ framework for COVID-19 vaccine allocation recommended that frontline health care workers who have the potential for direct or indirect exposure — including pharmacists administering the vaccine — should be among those who receive the first available doses of COVID-19 vaccine.

Ensuring the financial strength of supermarket pharmacies is even more important during the ongoing health emergency. Despite our members’ heroic efforts in response to COVID-19, the anticompetitive practices of pharmacy benefit managers continue to threaten supermarket pharmacies. We know how efficient and cost effective supermarket pharmacies are at delivering affordable and accessible prescription medicines to consumers and patients. However, the inappropriate use of direct and indirect remuneration (DIR) fees by PBMs threatens our industry’s ability to provide these valuable services.

A lack of transparency and oversight currently allows PBMs to use DIR fees to extract funds from pharmacies retroactively — weeks or even months after prescriptions are filled at the pharmacy counter. Since there is no way to anticipate these arbitrary and opaque fees, pharmacies often realize long after a prescription is filled that they did not even recoup their costs on the transaction and may force more pharmacies to close. Furthermore, pharmacy DIR fees hurt patients by increasing their out-of-pocket costs for needed medications.

According to the federal government, pharmacy DIR fees have increased by 45,000% in less than 10 years! In an industry that operates on razor-thin profit margins, supermarket pharmacies have virtually no ability to absorb these unexpected costs. As a result, patients are facing higher out-of-pocket costs for needed medications while pharmacies are struggling to stay in business

Throughout 2020, we worked closely with the Department of Health and Human Services and Congress to demonstrate that the current scheme of pharmacy DIR fees cannot be sustained and that our patients will suffer. If pharmacy DIR fees are not addressed soon, the impact on our members and their ability to care for patients in such a system will be significantly impacted. Therefore, it is imperative that pharmacy DIR reform is achieved in 2021, whether through regulation or Congress, as the situation gets more and more dire every day. Unfortunately, abusive, anti-competitive PBM practices put many supermarket pharmacy operations at risk and make it more likely that food retailers will be forced to close their pharmacies’ doors.

Some FMI members have stopped operating pharmacies or adding pharmacies to food stores, and many others struggle to maintain the financial viability of their pharmacies. According to “The Food Retailing Industry Speaks” report, 81% of FMI members said they will keep their pharmacy investments the same or decrease them in the next two years due to these challenges.

In an effort to curb PBM abuses, FMI filed an amicus brief with the U.S. Supreme Court in support of a state’s ability to pass legislation governing anti-competitive or abusive practices by PBMs. The issue before the court in Rutledge v. Pharmaceutical Care Management Association considers whether a preemption provision in the federal ERISA statute permits states to enact legislation that governs practices of PBMs. FMI supports the Arkansas statute that the Supreme Court is reviewing, 2015 Arkansas Act 900 (Act 900) and similar laws. This legislation protects public access to health care through pharmacies without altering the uniform administration of ERISA plans. In October, we were pleased the Supreme Court heard oral arguments on the case.

Supermarket pharmacies play a unique and significant role — now more than ever — in providing American consumers with convenient access to a full range of pharmacy and wellness services, and our pharmacists look to play a key role in administering the COVID-19 vaccine and a wide variety of immunizations.

Peter Matz is the director of Food and Health Policy at the Food Marketing Institute.