Sean Dengler.

When I was a child, I wandered the small pharmacy near the end of Second Street, formerly known as Wright Pharmacy. Now known as NuCara Pharmacy, most memories are of being with my grandma, Mildred, at the pharmacy after or before she picked me up from daycare. While this was over 25 years ago, my memory might be a little shaky on the reason why I was there. The part of the memory which I know is real is grandma let me pick out several types of Frooties. While I like to think we were at the pharmacy to help with my sweet tooth, it was for my grandma to pick up her and my grandpa’s prescriptions.

This pharmacy played and continues to play a vital role in the community. The location helps others from having to drive farther to pick up needed prescriptions. Unfortunately, it is hard for independent pharmacies to stay open. According to the Iowa Pharmacy Association, 29 Iowa pharmacies closed their doors in 2024. Across the country, 2,300 pharmacies closed with approximately half being independent community pharmacies or small to mid-sized chain pharmacies.

I can only imagine NuCara might be facing the same headwinds and by headwinds, I mean an oligopoly of three pharmacy benefit managers (PBMs). These powerful intermediaries buy drugs from the drug manufacturer and then sell to the pharmacies. Here’s an explainer about how PBMs work and how they became so powerful: https://www.thebignewsletter.com/p/inside-the-mafia-of-pharma-pricing.

As with other parts of life, the original intent to help buy drugs from manufacturers instead of individual pharmacies was good. Unfortunately, PBMs have changed for the worse as they have consolidated into three large firms. These PBMs can make pharmacies sign exclusive contracts which require consumers to use PBM-owned pharmacies according to the IPA. Due to these contracts and market power, they can also reimburse pharmacies for less than the cost of a drug and the services provided to dispense it.

In simple terms, when you go to a pharmacy and pick up a prescription, you pay, and you are out the door. On the pharmacy side of the equation, they have not been reimbursed for the cost to get the drug and the cost of business at this moment in time. They must wait for the PBM to reimburse them, which can be weeks if not months later. On top of this, the PBM does not have to reimburse them at cost. This causes the pharmacies to have a tough future to plan for and still lose money, leading to pharmacy closures and consolidation. Pharmacies are left with the short end of the stick.

This unfair process has been going on for a long time. Fortunately, states have begun to fight back. In 2024 alone, 33 bills were enacted in 20 states, including Iowa, which related to the regulation of PBMs according to Multistate. Iowa currently has a bill ready for debate, HF 852, which would go further in protecting pharmacies and consumers against the harmful impacts of PBMs.

It is particularly important to keep these pharmacies open across the entire state. It keeps wealth in the community, prevents people from traveling farther to do life-saving medication, and it keeps more businesses open. The United States already has deserts in health care, maternal care, and food. Pharmacies do not need to be added to this sad list. Let your legislators know you want to keep your local pharmacy. This way you can get your prescription with ease and let your grandchildren enjoy a piece of candy.

Sean Dengler is a writer, comedian, farmer, and host of the Pandaring Talk podcast who grew up on a farm between Traer and Dysart. You can reach him at sean.h.dengler@gmail.com.