WED AM News: Independent pharmacies feeling squeezed by pharmacy benefit managers; Midwest Express Airlines returning to Wisconsin

— Independent pharmacies in the state are feeling squeezed by intermediaries called pharmacy benefit managers via lower reimbursements, limited drug choices and preferred pharmacies. 

“PBMs are by far the biggest reason you see so few truly independent pharmacies any more,” said Matt McGowan, a pharmacist from Mount Horeb. “PBM reform has to happen, and it has to happen soon, or the local pharmacies so many people in Wisconsin and throughout the nation trust for their front-line health information will soon be a thing of the past.”  

McGowan practices retail pharmacy at the independently owned Mount Horeb Pharmacy and also works with Hometown Pharmacy, which operates more than 30 independent pharmacies in the state. 

Businesses like these have been struggling in recent years, with more than 16 percent of the country’s independent rural pharmacies closing between 2003 and 2018, according to the RUPRI Center for Rural Health Policy Analysis at the University of Iowa. 

McGowan says many of these companies have been driven out of business by “alarmingly low reimbursements” as more and more patients have prescription insurance. That’s particularly problematic in rural communities, where independent pharmacies have relatively low bargaining power due to their smaller size and patient populations. 

“Pharmacists are often ranked as one of America’s most trusted and knowledgeable health professionals. Many patients who have questions trust their local pharmacist most,” McGowan told “If pharmacies continue to close their doors because of decreasing reimbursements and increasing penalty fees, who will these patients turn to for their questions?” 

In a statement, the Pharmaceutical Care Management Association pushed back on criticisms leveled by independent pharmacies. The PCMA is the national trade group representing PBMs. 

“Pharmacy benefit managers are the advocates for consumers and health plan sponsors in the fight to keep prescription drugs accessible and affordable,” the group said. “PBMs have been able to achieve an overall stable cost trend for prescription drugs by innovating consumer-friendly, market-based tools that encourage competition among drug manufacturers and drugstores.” 

The nation’s top PBMs have relationships with the largest pharmacy chains in the country. CVS Health/Caremark works with CVS and Target; Express Scripts is connected to Walgreens; and Humana and WalMart are also linked. The top two — Express Scripts and Caremark — had just under 50 percent combined market share in the United States in 2017. 

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— Midwest Express Airlines is returning to Wisconsin after signing an agreement with Maine-based Elite Airways to begin non-stop service from Milwaukee’s Mitchell International Airport. 

According to a release, Elite Airways will operate the initial aircraft and provide flight crews and maintenance service for Midwest Express. But customer-facing elements of the flight service, including branding, will be all Midwest Express. 

Midwest Express Airlines began in Oak Creek in 1984, and later grew to serve 28 airports across the United States. The name was eventually shortened to Midwest Airlines in 2002. Eight years later, the airline’s parent company at the time, Republic Airways Holdings, announced Frontier and Midwest Airlines would merge, spelling the temporary end of the Midwest brand. 

The business is now being revived under its original Midwest Express brand in an effort led by company President Greg Aretakis. 

“This agreement with Elite Airways is a key step to bringing much-needed nonstop service back to Milwaukee,” Aretakis said. “By partnering with Elite, we expedite bringing our service to the market while we pursue federal licenses required to operate independently.”

See the release: 

— Alliant Energy’s latest corporate sustainability report shows the company is working toward eliminating coal from its energy mix by 2050, after announcing the goal last year. 

The Madison-based utility plans to own 12 wind farms by the end of 2020, with capacity to power 600,000 homes. That’s equal to the energy needed to power about 60 percent of the company’s residential customers. 

Aside from its coal-free pledge for 2050, the company is also moving toward a 40 percent reduction in carbon emissions from 2005 levels by 2030, and an 80 percent reduction by 2050. 

Between 2016 and 2020, the company is spending more than $2 billion on wind generation facilities. 

Alliant currently has four solar facilities in service and plans to expand that number as part of its transition to clean energy. The company is planning solar systems near its two newest natural gas-fired generating stations, located in Iowa and near Beloit. 

The report also highlights efforts to improve reliability by placing electric lines underground, rather than overhead. More than 20 percent of the company’s lines are now underground, and the company plans to install most new electric lines underground, as well as any that need replacing. 

According to the report, the cost of putting these lines underground has “come down significantly.” Accounting for the full life cycle cost of burying lines compared to putting them above, the company says the cost is about the same. But placing them below ground has other benefits, including fewer outages and increased safety for people and wildlife. 

Alliant Energy provides electric and natural gas service to 960,000 electric and 410,000 natural gas customers in Iowa and Wisconsin.  

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— Following this year’s first case of eastern equine encephalitis in Wisconsin, UW-Madison is highlighting the impact this virus can have on both horses and people. 

Before DATCP recently announced the case of EEE, it was confirmed July 31 at UW-Madison’s Wisconsin Veterinary Diagnostic Laboratory. 

“Unfortunately, there is no treatment for this infection,” says Ailam Lim, section chief of virology at the laboratory. “Often, even before a lab diagnosis is complete, the animal must be euthanized since it is so weak and the chance of survival is so low. Those few that survive will have symptoms and neurological signs.”

Infected horses often present fever, lethargy, lack of appetite, aimless walking and other abnormal behavior, according to Fernando Marques, clinical associate professor at the UW-Madison School of Veterinary Medicine. 

“There may be lethargy or depression. There is a range of severity,” he said in a release. “Some seem completely out of their minds, crazy.” 

The virus is more treatable in humans, according to the release, but people often suffer impediments to their movement and memory. 

Mammals such as humans and horses can’t pass EEE to one another. It’s usually transmitted through mosquito bites. With a wet spring and early summer in Wisconsin, the mosquito population is larger and poses more of a risk of infection. 

Keith Poulsen, lab director for the Wisconsin Veterinary Diagnostic Laboratory, says EEE infections in people are rare but serious. He says the risk can be lowered with clothing and repellents designed to repel mosquitoes. 

See the release: 

— Executives from some of the Milwaukee area’s top manufacturers — Komatsu Mining, Twin Disc and Badger Meter — will be featured at the upcoming BizTimes Next Generation Manufacturing Summit Oct. 9 in Milwaukee. 

Other speakers include Bill Berrien, CEO for New Berlin-based Pindel Global Precision; and Stacy Peterson, president and CEO of Big Bend-based Connoils.  

See more on the event in Manufacturing headlines below, and register here: 


# Midwest Express Airlines partners with Maine-based carrier to launch initial service at Mitchell

# Potawatomi wants to build casino in Waukegan, Illinois

# Is your neighborhood gentrified? Madison report identifies areas of displacement

# Cost of farming went down in Wisconsin last year



– Crop reports say last week was good for farmers

– Wisconsin hits 7th month of lower cheese production


– Chase Bank to build new branch in Glendale


– WEDC study: State’s paper industry still leads the nation


– Research on industrial hemp to be featured during field day


– WEC Energy Group still sees solar as an option for Foxconn’s energy needs


– Construction underway on Advocate Aurora medical center in Sheboygan County

– NFMC’s Heiberger to lead ISASH farm safety group


– American Family Insurance venture arm launches $200M investment fund


– Milwaukee trucking firm expanding statewide, creating 40 jobs in Racine


– Jennifer Provancher named president of The Equitable Bank


– Komatsu, Twin Disc and Badger Meter CEOs to headline BizTimes manufacturing event

– Wisconsin paper industry optimistic a decade after Great Recession, study finds


– An industry giant: Gannett will get larger with GateHouse merger


– Evers, Barnes push Wisconsin Medicaid expansion despite Republican opposition


– Illinois civil engineering firm opens downtown Milwaukee office


– Outdoor retail chain Sierra opening in Brookfield this weekend


– Viking Electric expanding its Wauwatosa facility


– DNC road trip: Convention organizers book hotel rooms in Madison and Illinois


– Midwest Express to return with nonstop flights from Milwaukee

– Midwest Express signs agreement with Maine airline to launch service


– Margaret Krome: Citizen input will improve livestock siting rules


<i>See these and other press releases: </i>

Acuity Insurance: Acuity Health Challenge raises over $15K to benefit behavioral health and wellness

Alliant Energy: Highlights progress toward a cleaner energy future

Midwest Express: Signs agreement with Elite Airways to provide initial service from Milwaukee

Bradley Corp: Announces the appointment of Luis de Leon to Executive Vice President