Oregon’s pharmacy access crisis is no longer a looming threat. It’s a full-blown emergency, with Oregon ranking dead last in the continental U.S. in retail pharmacy access. Hundreds of pharmacies have shuttered over the last decade, and the local community-based retail pharmacy industry is nearly non-existent. The typical experience at retail pharmacies has eroded over the years to become almost unbearable — long waits, understaffed pharmacies, almost no 24-hour options and so on. But none of that is the fault of the professionals caring for patients — it’s the direct result of the unconscionable business practices happening behind the scenes. As someone who has spent more than 20 years working across the pharmacy and health care spectrum, I can say unequivocally that predatory pharmacy benefit manager (PBM) practices are the root of the problem.

The Legislature must act now to pass meaningful PBM reform in House Bill 3212. This bill addresses the root of the crisis: unchecked, exploitative contracting practices by PBMs that are driving pharmacies out of business. It is a necessary step the Oregon Legislature must take this session to protect community pharmacies and the patients who rely on them. Pharmacies have no leverage against the massive corporations controlling drug payments to pharmacies, and Oregon must take steps to level the playing field or we will lose even more pharmacies.

For every independent pharmacy that disappears, patients lose more than a place to fill prescriptions. They lose a trusted health advisor, a source of immunizations and chronic disease support, and one of the most accessible health care providers they have. Community pharmacies are often the only source of care in rural and underserved areas. Throughout my career, I have seen firsthand how essential these providers are to population health outcomes. Further destruction of the pharmacy industry will harm underserved areas the most.

PBMs seem to have little concern for this problem, as they fare better by forcing prescriptions to their own pharmacies anyway. They use opaque pricing, “take-it-or-leave-it” contracts and reimbursement rates that fall below the cost of the drugs being dispensed. In some cases, chain pharmacies owned by PBMs’ parent companies receive twice the reimbursement for the same medication compared to an independent. Community pharmacies have no hope in competition in such a skewed and manipulated market.

I have helped build and rebuild pharmacy operations across Oregon and beyond. I have worked with teams to optimize systems, control costs and streamline services. Unfortunately, there is no strategy or optimization that can overcome being paid less than the pharmacy’s acquisition cost. That is the reality many Oregon pharmacies, both large and small, face right now. Without legislative action, more pharmacies will be lost.

HB 3212 offers a clear, fair solution. It reins in PBM abuse by requiring fair and transparent contracts. It prohibits patient steering that strips choice from consumers and guts local access. And it ensures pharmacists are no longer gagged from telling patients and employers the truth about cheaper alternatives or coverage gaps. These are not radical ideas. They are common-sense protections for both providers and patients.

PBMs are trying to kill this bill by arguing it could raise patient costs and claiming they are the only entity that fights to reduce drug prices. But let’s be honest —the current state of drug prices is nothing to brag about. In fact, PBMs are incentivized to drive the market in the opposite direction, something they’ve excelled at. Just look at drug pricing in the rest of the industrialized world (who largely do not use PBMs or many other constructs we have here) and you’ll see PBMs have done the opposite of what they claim. It turns out the unchecked consolidation and power of PBMs has driven the market in exactly the direction they hoped. We are experiencing precisely what our system incentivizes: less access, higher prices and poor patient outcomes. A course correction on the PBM industry is long overdue.

The Legislature must step up, look past the PBM industry propaganda, and acknowledge the reality they can see with their own eyes in their districts. Community pharmacies cannot wait another year let alone two. HB 3212 will not solve every problem, but it will restore some fairness to a system rigged against the pharmacies trying to care for their patients and communities.

We have reached the tipping point. The question now is whether lawmakers will side with Oregon pharmacies and the patients they serve, or the massive corporations that are destroying them.