ICYMI: What’s Behind the PBM Curtain? Abuse, Wealth, and Barriers to Health: US Representative Buddy Carter

The curtain has been pulled back on the harmful business practices of Pharmacy Benefit Mangers (PBMs) that leave patients struggling to afford needed treatment, drive independent pharmacies to close their doors and neglect the expertise of medical professionals. This leads to severe delays, expensive drugs and poorer health outcomes for patients.

In case you missed it, Congressman Buddy Carter released a report on PBM abuses, complete with patient testimonials highlighting the ways these middlemen have negatively impacted their health. Here are the highlights:

Yuri: “How are we supposed to live a decent quality of life when the very structures that help us are designed to hurt us?”

“It’s a person behind a computer that makes your life difficult, not yours, or in my case, my paralyzed stomach.”

“Traumatic, I think that doesn’t really scratch the surface, really, once you’ve been through it or watched a lover go through it.”

“I have the rarest of the rarest diseases and it took until the last decade for therapies to be approved.”

“If there are drugs that would help me regain my independence, then I should be able to access them.”

“I would not say [PBMs] have helped me at all. In fact, I would say step therapy is a hindrance.”

“Sometimes dealing with the administrative side of being sick is worse than the disease itself.”

Watch the full video here.

Prescription drug pricing reform needs to grip pharmacy managers

By: Buddy Carter and Terry Wilcox

October 18, 2022

Washington Times Opinion) – This month, President Biden signed an executive order directing federal health departments to create plans within 90 days to reduce the prescription drug costs that burden so many Americans. Any robust program to provide meaningful financial relief to patients at the prescription counter must address the root cause of skyrocketing drug prices—pharmacy benefit managers (PBMs)…

PBMs are intermediaries between pharmaceutical manufacturers, pharmacies and health insurers. They artificially raise prices, encouraged by a lack of transparency in the drug pricing chain, without providing any value to consumers. The top three PBMs, which account for nearly 80% of the nation’s prescriptions, are owned by health insurance companies, creating a huge conflict of interest.

PBMs dramatically inflate drug prices by demanding huge rebates from manufacturers in exchange for placement on insurers’ lists of covered drugs, known as formularies. Since 2006, when PBMs took a more active role in the market, drug prices have increased 313%. Annual rebates now exceed $200 billion, approaching half of the nation’s prescription drug market.

In 2020, total gross spending on brand name drugs reached $517 billion. Producers earned only 31% of these costs, while intermediaries made 69%. One analysis concluded that $339 of the $425 cost per box of insulin pens were rebate dollars. PBMs and their pay-to-play rebate scheme explain why this 100-year-old drug remains out of reach for so many people.

By excluding low-discount drugs from formularies, PBMs also routinely prevent patients from getting the drugs they need. The three largest PBMs block more than 1,150 treatments from formularies, including a low-cost insulin alternative called insulin glargine. Patients prescribed these drugs often have to endure long waits, so-called step therapy (in which insurers force patients to try and fail formula drugs first) and much higher costs.

Read the full article here.

“PBMs are shutting down pharmacies, especially independent retail pharmacies.

“4% of all independent retail pharmacies fail each year. This will create pharmaceutical deserts if you will.

“And when that happens, especially in rural areas, then you’re going to … you’re going to lack the most accessible health care professionals here in America.”

“It’s bad for health care.”

Listen to Congressman Carter’s full interview here.

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