Statement on Near-Term Congressional Efforts to Improve Prescription Drug Affordability

Congress should prioritize affordability of medicines needed by Medicare beneficiaries suffering from diabetes and other chronic conditions


FOR IMMEDIATE RELEASE

July 15, 2022


Washington, DC – Mark Blum, Managing Director of the PBM Accountability Project, issued the following statement in response to renewed efforts on Capitol Hill to help make prescription medicines more affordable:


“Over the past year, attorneys general, legislators, and governors of states across the country, as well as many private sector employers, have taken decisive action to prevent pharmacy benefit managers (PBMs) from exploiting perverse incentives to drive up the costs of prescription medications. Congress should follow suit with actions to protect Medicare patients and take critical first steps to address predatory PBM business practices.


“For example, an extensive bipartisan investigation conducted by the Senate Finance Committee in 2021 found that PBMs have received insulin rebates amounting to discounts of up to 70 percent from manufacturers’ list prices. Yet the same PBMs frequently base patient copays on the list price, prior to discount, resulting in inflated patient out-of-pocket costs for insulin that could run as high as $300 per vial. Chronically ill Medicare beneficiaries should not have to fear that they cannot afford prescription medicines they need. A proposed congressional measure to cap Medicare patient out-of-pocket costs at $35 for insulin and other chronic disease medications will provide the security that every retired or disabled American deserves.


“A sustained solution to the crisis of prescription drug affordability cannot be achieved without eliminating the perverse financial incentives that drive unacceptable PBM behaviors. Competitive PBM markets with transparent pricing for PBM services need to be created in lieu of the complex PBM arbitrage schemes (“the games PBMs play”*) and questionable PBM business practices that currently prevail. More robust PBM accounting and reporting requirements are needed. The vertical integration of the largest PBMs, specialty pharmacies, and commercial insurance companies needs to be addressed.


“Regarding the latter concern, it is encouraging that the FTC has finally embarked on investigating the business practices of PBM oligopolists that process more than 80% of prescription drug claims and the possible application of anti-trust law. But there is much more that Congress can and should do to protect American taxpayers, patients, workers, and employer health plan sponsors exploitation by corporate PBM middlemen.


“Limiting Medicare patient prescription drug copays to an out-of-pocket maximum is an important first step, but more must be done to solve the entire problem of PBM profiteering at taxpayers’ and patients’ expense. Recent poling shows there is overwhelming support among both Democratic and Republican voters on the proposed $35 Medicare prescription drug copay cap. If members of Congress are genuine in their expressed wish to assure prescription drug affordability for all Americans, they now have the opportunity to demonstrate it by supporting a very popular measure. Now is the time for Congress to make progress toward the national goal of prescription drug affordability for all Americans.”


To learn more about the games PBMs play, click here.


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About The PBM Accountability Project

The PBM Accountability Project brings together leaders and stakeholders across healthcare, labor, business, pharmacy and consumer patient advocacy to help ensure that patients and our private and public sector health plans aren’t overpaying for the prescription medicines we need. Our organization is working to educate the public and advance solutions to help redirect prescription drug savings from very high PBM profits back to patients, employee health plans and taxpayers. To learn more about the PBM Accountability Project, visit pbmaccountability.org.