Yesterday, the Committee on Oversight and Accountability of the House of Representatives issued a press release (here) after the hearing on Pharmacy Benefits Managers (PBMs) and their impact on drug pricing. The press release is titled “Hearing Wrap Up: Pharmacy Benefit Managers Push Anticompetitive Drug Pricing Tactics to Line Their Own Pockets.” I guess this title sums up the Committee’s current take on PBMs, their lack of transparency, and the impact on the pocketbooks of patients and pharmacies! Both Republicans and Democrats came out on the same side as their comments will likely resonate with their constituents. The first line after the title in the press release reads, “Oversight Committee continues to shine a light on the PBM industry,” which also adds flavor to the committee members’ comments.
Key issues identified in the press release focused on spread pricing, negotiated contracts that keep generics and biosimilars out of formularies in favor of brand-name products, lack of PBM transparency, PBM rebate practices, how PBMs are impacting drug availability in rural areas, and their impact on small pharmacies.
The press release quotes Mr. Craig Burton, Executive Director, Biosimilars Council: “When PBMs pursue varying rebate agreements with plan sponsors, coverage of generics is delayed and patients suffer as a result. These delays in coverage restrict patient access to lower-cost generics and expose patients to unnecessarily high cost-sharing, even though lower-cost alternatives are available.”
It also quotes Mr. Hugh Chancy, Pharmacist Owner, Chancy Drugs: “PBMs use a variety of methods to steer patients away from unaffiliated pharmacies. They create differential cost-sharing structures and arbitrary lists, such as specialty and aberrant drug lists, among other schemes, to limit independent pharmacies’ access to patients.”
The PBM issue has been discussed more in the last five to six years as PBMs have consolidated and now three PBMs control 80% of the marketplace. Also, the committee noted that many of the PBMs are “owned by a major health insurer and owns, or is owned, by a pharmacy.” Read the press release for selected comments by congressional members. But talk alone does not help consumers; now is the time that the rubber must meet the road! We will have to see what actions come of the many pieces of legislation and how the political parties can turn “talk” into meaningful action to better protect consumers!
