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PBM Accountability Project and More Than 40 Stakeholder Organizations Urge Meaningful Action on PBMs

Leading Patient, Provider, Pharmacy, Labor, Anti-Monopoly and Employer Groups Seek Congressional Reforms to Require PBM Transparency, Protect Patient Access to Local Pharmacies, and Restore Affordability of Prescription Medicines

The PBM Accountability Project sent a letter to Members of Congress as they weigh legislative action to lower healthcare costs for Americans, encouraging meaningful solutions to hold pharmacy benefit managers – or PBMs – accountable for their role in driving up out-of-pocket costs for prescription medicines. More than 40 organizations signed the letter; they represent a wide range of groups, including patient advocates, pharmacists, providers, and labor, anti-monopoly and employer organizations.

“Fortunately, Congress has an historic opportunity, right now, to make corrections to the prescription drug market that will eliminate the perverse incentives PBMs currently have to raise, rather than lower, prices of prescription medicines,” said Mark Blum, managing director of the PBM Accountability Project. “Recent polling shows that Americans of both parties, as well as independents, stand in overwhelming support of enacting these corrections to be sure Americans are paying the absolute minimum cost for prescription drugs.”

PBM business practices continue to boost their revenues at the expense of American patients, families and taxpayers. Their role as middlemen corporations in the drug pricing system has led to increased costs and access barriers for the prescription medicines Americans rely on.

“We’re encouraged to see leaders in Congress and across the states taking note of the way PBMs appear to put their own profits over patients without adding value to the healthcare system,” said Sally Greenberg, CEO of the National Consumers League. “Our letter clearly lays out common-sense policy solutions that will help address these issues to ensure consumers pay less for the medications they need. It’s a win-win for all.”

David A. Balto, former policy director at the Federal Trade Commission, added: “PBMs continue to get away with schemes that interfere with the free market process and prevent consumers from getting drugs at the lowest price, and it’s time to put an end to these predatory practices.”

In the letter, organizations commit to the fundamental principle that: “No American should pay more than is the minimum cost necessary for the prescription drugs they need, and all Americans have a right to access affordable health care at the pharmacy that they have come to trust.”

Specifically, the letter encourages lawmakers “to enact legislation this year that includes the following provisions:

  • Break the link between price of medicines and PBM revenues: PBMs can earn money only from a single, flat administrative fee for services they provide, but PBMs may not earn any revenues from manipulating prescription drug prices or imposing charges that are greater than PBMs’ own net cost of acquisition.

  • Assure that no patient pays any more than the minimum cost necessary for the prescription medicines they need: PBMs must pass all prescription drug price discounts and related revenues, including but not limited to any rebates, reimbursements, and assessed administrative and non-administrative fees, through to health plan sponsors and patients; the patient/plan participant cost share in any health plan must be based on the discounted acquisition cost of the prescription drug – that is, the net cost – and not on the list price or any other higher price point.

  • Require reasonable and actionable PBM data transparency: Public and private sector health plan sponsors must be able to access and review PBM pricing data, including the price a PBM charges and any rebates, discounts, administrative fees, etc. the PBM receives, to validate that PBMs are not earning any revenues from manipulating prescription drug prices or imposing charges greater than PBMs’ own net cost of acquisition.

  • Protect patient access to the pharmacy of their choice: Prevent PBMs from driving patients to their self-owned pharmacy operations and ensure pharmacy reimbursements cover both net acquisition cost and the cost of dispensing prescription medications.”

To read the full letter, click here.


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