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Image source: Committee on Oversight and Accountability website, oversight.house.gov/report (PBM Report). Pictured is the cover image to the July 23, 2024 report, "The Role of Pharmacy Benefit Managers in Prescription Drug Markets."
7-28-2024 11:49am
Rep. Auchincloss Introduces Bipartisan Bill to Address Anti-Competitive Practices in Prescription Drug Market
Darlene Cancell
Editor
On July 23rd, U.S. Representative Jake Auchincloss (D, MA-04) introduced a bipartisan bill with Representative Diana Harshbarger (R, RN-01) to address predatory drug pricing by pharmacy benefit managers (PBMs) – the intermediaries between drug manufacturers and health insurance providers -- which have been found to be costly to consumers, and harmful to local pharmacies.
"The corporate greed of PBMs and their health-insurance overlords has taken money directly out of the pockets of seniors, taxpayers, and pharmacists by inflating the price of medications for their own benefit. This bill protects community pharmacists and patients from price-gouging in federal healthcare programs,” said Rep. Auchincloss.
Monique Whitney, Executive Director of Pharmacists United for Truth and Transparency (PUTT), said, “This legislation is vital to ensuring patients can maintain access to the pharmacy of their choice, but also - critically - ensuring pharmacies remain viable and open for patient care.”
Called the Pharmacists Fight Back Act, the bipartisan proposed legislation would:
- Remove the ability of PBMs to restrict patient choice;
- Prohibit PBMs from steering patients to PBM-affiliated pharmacies; and
- Implement a transparent pharmacy reimbursement model based in part on market-based pricing and average drug acquisition cost.
The bill joins at least eight other bills proposed by this Congress to tackle problems in the current PBM market. According to the Office of Congressman Auchincloss, the Pharmacists Fight Back Act is the most comprehensive, and PUTT calls it “the first and only bill to directly address PBM practices that have left hundreds of communities without pharmacies.”
Also on July 23rd, the House Committee on Oversight and Accountability issued a staff report finding that “anti-competitive policies of the largest PBMS have cost taxpayers and reduced patient choice.” The report follows the committee’s investigation after 2.5 years into PBMs, over concerns about escalating costs of prescription drugs. The committee’s report states a finding that PBMs “inflate prescription drug costs and interfere with patient care for their own financial benefit.”
The three largest PBMs are CVS Caremark, Cigna Express Scripts, and UnitedHealth Group’s Optum RX. Each of these PBMs owns pharmacies. They control over 80 percent of the market, and are vertically integrated with health insurers, pharmacies, and providers.
The committee found that the three largest PBMs used their positions as middlemen in prescription drug markets to steer patients to PBM-owned pharmacies, favoring their own pharmacies over competitors. Local and independent pharmacies have trouble competing with the large PBMs, according to the committee report.
“As a pharmacist, I know first-hand how pharmacy benefit managers maneuver in the shadows to put the financial screws to independent community pharmacies, and often raise drug costs for patients by steering prescription drug coverage to whatever best pads their bottom line,” said Rep. Harshbarger.
The committee found that PBMs position higher cost medications in more preferable positions on health insurance plans. This makes expensive medications more accessible to wider range of patients, even though lower-cost, equally effective and safe options may be available.
“Unfortunately, the PBM preferred drug is often not the best drug for a patient but the most profitable drug for the PBM,” the committee report quotes Dr. Miriam Atkins as saying. Dr. Atkins is an oncologist from Augusta, Georgia.
Americans spend more on prescription drugs than any other country, with prices that can be more than double the cost of identical drugs in other high-income nations.
