Howard Jacobson sat in his car outside a Long Island rehab center, holding a box of medication that cost him more to buy than he would be reimbursed to dispense. The longtime pharmacist, who owns Rockville Centre Pharmacy and West Hempstead Pharmacy, says moments like this have become routine in an industry he once believed had room for sustainable community care.
For Jacobson, who has spent nearly four decades behind a pharmacy counter, the crisis is no longer abstract. It is existential.
Independent pharmacists across New York describe the same pattern: reimbursement rates from pharmacy benefit managers — the middlemen known as PBMs — frequently fall below the cost of the drugs they dispense. PBMs negotiate prices on behalf of insurance plans, adjudicate claims and determine how much pharmacies get paid. But with three companies controlling nearly 90 percent of the national market, pharmacists say they have little leverage…