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Fixing the PBM Problem Is the Silver Bullet for Lowering Drug Costs in America

Common Sense PBM Reforms Are Needed Now to Make Medicines More Affordable


August 10, 2022

Washington, DC – Mark Blum, Managing Director of the PBM Accountability Project, issued the following statement in response to Senate passage of the Inflation Reduction Act:

“Congress just took an important first step to lower out-of-pocket costs for patients at the pharmacy counter by including in the Inflation Reduction Act a $35 out-of-pocket maximum copay cap on insulin for Medicare patients. This step will provide urgently needed financial relief for American seniors suffering with diabetes. However, much more remains to be done to prevent middlemen pharmacy benefit managers (PBMs) from driving up the costs of prescription medicines for all Americans. The important achievement of enacting a Medicare out-of-pocket insulin cost cap is truly significant -- but it is just one piece of the solution that is needed urgently to end PBM profiteering at the expense of American working families, employers, and patients.

“We urge Members of Congress to build on their historic insulin cost-containment achievement immediately, rather than relinquishing momentum to PBM lobbyists and Members of Congress who have chosen to serve the interests of PBMs over American taxpayers and patients. Now is the time for Members of Congress to stand up and expand the copay cap to a broader range of chronic disease medications, assuring that these life-saving prescription drugs are affordable for all Medicare patients who need them. Congress must take steps to increase competition and transparency in the PBM commercial and public sector marketplaces. Now is the time for lawmakers to seize the momentum to address questionable PBM business practices, eliminate complicated PBM arbitrage schemes, and end perverse PBM incentives to drive up cost of prescription medicines.

“We applaud the bipartisan majority in the US Senate and House of Representatives who stood up against intensive and well-funded PBM lobbying to cast votes to expand the $35 insulin out-of-pocket copay cap into the PBM-dominated commercial marketplace. The success of their effort would have assured affordable access to life-saving insulin for tens of millions of suffering Americans who are not yet eligible for Medicare. Although the bipartisan effort in the Senate fell 3 votes short of the 60 votes needed to expand the $35 insulin cap beyond Medicare, it was nonetheless a historical milestone demonstrating that effective PBM reform needed to achieve prescription drug affordability for all Americans has moved well within reach.

"Despite obstructive PBM lobbying, momentum is growing toward enactment of effective PBM reforms. A bipartisan investigation conducted by the Senate Finance Committee in 2021 found that rebates PBMs received for insulin weren’t being passed down to patients by way of out-of-pocket savings. In a historic decision, the FTC has launched an investigation of the questionable business practices of PBMs and their affiliates. And now, Congress has enacted a significant Medicare patient out-of-pocket copay cap.

“The PBM Accountability Project looks forward to working with Chairman Wyden, Ranking Member Crapo, Chairwoman Cantwell and other leaders to build on these important advances to make effective PBM reform a central priority of Congress’ strategy to guarantee prescription drug affordability for all Americans. That’s the silver bullet Americans are looking for.”

For more on recent Congressional Efforts to improve prescription drug affordability, and the PBM Accountability Projects work, click here. To learn more about the games PBMs play, click here.



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