Nearly two dozen conservative groups sent a letter to Congress today urging passage of common sense legislation to reform some of the ways in which pharmacy benefit managers (PBMs) interact with government programs like Medicare and Medicaid.
The full letter is linked above. Below is an excerpt:
The undersigned organizations, comprised of conservative and free enterprise grassroots and public policy organizations, strongly support the bipartisan PBM transparency and accountability reforms that passed through the Senate Finance Committee – the Modernizing and Ensuring PBM Accountability (MEPA) Act (S. 2973) and the Mental Health, Lower-Cost Drug and Extenders Package (S. 3430). These bills will help ensure that patients realize cost savings on their prescription drugs. We urge you to pass S. 2973 and S. 3430 this year.
PBM policies directly impact whether patients can access and afford their medicines. Common sense reforms are needed to ensure that PBMs are not able to set the price of prescription drugs, dictate decisions made between doctors and patients, and steer patients to their preferred pharmacies.
In addition, PBM reform inside government programs, which is what these bills focus on, will result in lower spending and cost savings for taxpayers. They are a down payment on critical spending cuts and regulatory reforms that will be pursued by the incoming Trump Administration. These common sense PBM reforms will make government entitlement programs smaller, something the next Congress will be asked to do in budget reconciliation. The time to cut spending is now.
Currently, PBMs are inflating their profits by preferencing more expensive medicines when designing formularies. By setting favorable prices and cost-sharing amounts, PBMs influence the amount that patients pay out of pocket and which medicines they can access through their insurance. If a drug isn’t on the formulary, insurers won’t cover it and often doctors won’t prescribe it—regardless of the patient’s medical needs...
The Modernizing and Ensuring PBM Accountability Act (S. 2973) would help to address this issue by resetting the money-making incentives to benefit patients by delinking PBM fees from the price of medicine. Breaking the link between the price of medicines and the fees PBMs charge will help to fix incentives in the system that drive up costs and improve patients’ access to affordable medicines.
The Mental Health, Lower Cost Drugs and Extenders Package (S. 3430) would also help address PBM profitmaking schemes. In the current landscape, PBMs are empowered to pocket discounts that are already provided by drugmakers alongside their products. This bill would ensure that the negotiated savings are passed on to patients at the pharmacy counter and help lower patient out-of-pocket costs.
Taken together, these efforts are common sense solutions that ensure PBM business practices drive lower costs and improve access to care for millions of Americans. It is time for Congress to act decisively and pass reforms that allow for greater competition in the pharmaceutical supply chain. To that end, we urge you to pass S. 2973 and S. 3430 this year.
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