CVS Caremark and Express Scripts Holding Co. have claimed that they don't use clawbacks,
西维斯公司和快捷药方公司声称，他们没有回扣行为，
but in a lawsuit filed against CVS Health Corp., plaintiff Megan Schultz stated that the practice was part of both PBMs' agreements with CVS pharmacies.
但在一起针对CVS Health Corp.的诉讼中，原告梅根·舒尔茨表示，药品利益管理机构与西维斯药店协议里有这方面的内容。
Many plans require pharmacists to collect payment when prescriptions are filled and prohibit them from waiving or reducing the amount.
协议规定，药剂师在配药时收取费用，并严禁他们放弃或减少费用。
Pharmacies who contract with -OptumRx, for instance, could be terminated for "actions detrimental to the provider network,"
例如，根据2016年药品福利管理公司的提供者手册，药店若有任何“有损于医疗护理提供者网络”的行为
doing anything that "disparages" it, or trying to "steer" customers to other coverage or discounted plans, according to OptumRx's 2016 provider manual.
做任何“贬低”，或者试图“引导”客户转向其它保险或折扣计划，其与药品福利管理公司的合约就会被终止。
"They're usually take-it-or-leave-it contracts," says Mel Brodsky, Executive Director of the Philadelphia Association of Retail Druggists.
费城零售药店协会的执行董事梅尔·布罗斯基表示：“他们通常有两个选择，要么接受要么放弃。”
Independent pharmacies in particular fear getting removed from re-imbursement networks, a potential death blow in smaller communities.
独立药店尤其害怕从医疗护理提供者网络中移除，这对较小的社区来说是一个潜在的致命打击。
A survey of 640 independent community pharmacists by the National Community Pharmacists Association found that 83 percent of the respondents see at least ten clawbacks a month.
美国国家社区药剂师协对640名独立社区药剂师的调查发现，83%的受访者每个月至少会收到10笔回扣。
"I've got three drugstores, so I see a lot of it," David Spence, a Houston pharmacist, says.
“我和三家药店合作过，所以我了解，”休斯顿药剂师大卫·斯宾塞说道。
"We look at it as theft—a way for the PBMs to steal."
“我们认为药品利益管理机构的做法属于偷窃行为。”
Many legislatures are responding.
许多立法机构正在作出回应。
At least 13 states have enacted laws prohibiting "gag clauses" that prevent pharmacists from telling customers about clawbacks;
至少有13个州颁布了禁止言论条款，药剂师不允许向顾客透露有关药品回扣的信息；
at least 22 additional states have similar laws pending.
至少有22个州也在等待颁布这样的法律。
In the meantime, when customers question their co-pay amounts, some pharmacists jump at the opportunity to explain how they can pay less.
与此同时，当顾客质疑他们的合作付款金额时，一些药剂师趁机向他们解释如何能支付得更少。
"Most don't understand," says Spence. "If their co-pay is high, then they care."
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