Congress trying to tackle rising prescription drug costs by cracking down on PBMs

WASHINGTON, D.C. — Nearly one in four people can’t afford their medications according to a Kaiser Family Foundation survey.

This has Congress trying to lower prescription costs by cracking down on the so-called middlemen between insurance companies and pharmacies. They’re called Pharmacy Benefit Managers or PBMs.

“People are being harmed and it’s because of PBM greed,” said Dr. Kevin Duane, a pharmacist.

Dr. Kevin Duane runs Panama Pharmacy in Jacksonville, Fl. He believes PBM’s are negatively impacting patients and local pharmacies.

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Because of PBMs, Duane said many military families who use TRICARE are limited to ordering medicine online or going to an on base pharmacy.

“The naval air base in Jacksonville is attempting to service more than three times the current patient load that they’re staffed and equipped to serve,” he told lawmakers Tuesday.

Congress estimates the three largest PBMs control about 80 percent of the market.

During a congressional hearing Tuesday, lawmakers from both parties argue that’s part of the problem.

“PBMs engage in self-benefiting practices that boost their bottom line without a benefit to patients,” said Rep. James Comer, R – Kentucky.

“No American should be forced to choose between living expenses like groceries, rent or transportation and affording their lifesaving medication,” said Rep. Jamie Raskin, D – Maryland.

The trade association representing PBM’s is called the Pharmaceutical Care Management Association. The group’s President and CEO, JC Scott, said they weren’t invited to share their perspective for this hearing.

In a statement, Scott said the committee risks “fundamentally misconstruing the role of pharmacy benefit companies and playing right into the hands of Big Pharma, which wants nothing more than to weaken this one check on big drug companies’ otherwise unlimited pricing power and avoid accountability for their egregious abuse of the patent system that blocks competition and keeps prices high.”

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Greg Baker who runs AffirmedRX, a smaller PBM, said the industry can help patients but currently lacks transparency.

“I think in general PBMs can do a job good making drugs more affordable,” said Baker. “If we understand where and how they’re making the decisions they’re making, they can help keep pharmaceutical manufacturers in check so they do not price gouge on the American public but again at the end of the day those things aren’t occurring as we sit here today.”

Lawmakers are also reviewing the tactics used by PBMs when it comes to federal healthcare programs.

Below is the full statement from Pharmaceutical Care Management Association about today’s House Oversight Committee hearing:

“To hold an Oversight hearing focused on one industry, without inviting a witness who can speak to the depth and diversity of that industry or offer a balanced perspective and answer key questions, should raise concerns about a powerful panel pursuing predetermined conclusions to pick winners and losers in the marketplace.”

“Without hearing from the wider industry in question, and without taking a broader look at the entire supply chain, the Oversight Committee risks fundamentally misconstruing the role of pharmacy benefit companies and playing right into the hands of Big Pharma, which wants nothing more than to weaken this one check on big drug companies’ otherwise unlimited pricing power and avoid accountability for their egregious abuse of the patent system that blocks competition and keeps prices high.”

“We encourage the committee to reconsider its approach to this investigation to ensure its findings, and any related policy recommendations, accurately and fairly consider the facts, and the negative implications for patients and employers of any government intervention in the market that undermines the cost-saving value of pharmacy benefit companies.” - JC Scott, President and CEO of PCMA

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