ICYMI: What’s behind the PBM curtain? Abuse, Wealth, and Barriers to Health: U.S. Representative Buddy Carter

The curtain has been drawn on the harmful business practices of Pharmacy Benefit Managers (PBMs), who force patients to scramble to pay for needed treatments, drive independent pharmacies out of business and ignore the expertise of healthcare professionals. This leads to tedious delays, expensive drugs and poorer health outcomes for patients.

In case you missed it, Rep. Buddy Carter released a report on PBM abuse, complete with patient testimonials highlighting how these intermediaries negatively impacted their health. Here are the highlights:

Yuri: “How are we supposed to live with a decent quality of life when the very structures to help us are put in place to hurt us?”

“It’s a person behind the computer who is making your life difficult, not your, or in my case my paralyzed stomach.”

“Traumatic, I think it doesn’t really scratch the surface, really, once you’ve been through it, or seen a loved one go through it.”

“I have the least rare of the rarest diseases, and it’s taken until the last decade for these to be approved.”

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

“I will not tell [PBMs] helped me at all. In fact, I would say the step therapy was a hindrance.”

“Sometimes managing the administrative side of the sick is worse than the disease itself.”

Watch the full video here.

Prescription drug pricing reform must hold back pharmacy benefit managers

By: Buddy Carter and Terry Wilcox

October 18, 2022

Opinion of the Washington Times) – 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 plague so many Americans. Any robust program to provide meaningful financial relief to patients at the prescription counter must address the root cause of soaring drug prices – Pharmacy Benefit Managers (PBMs)…

PBMs are intermediaries between pharmaceutical manufacturers, pharmacies and health insurers. They artificially raise prices, emboldened by a lack of transparency in the drug price chain, without delivering any value to consumers. The three largest PBMs, which account for nearly 80% of prescriptions nationwide, are owned by health insurers, creating a huge conflict of interest.

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

In 2020, total gross spend on brand name drugs reached $517 billion. Manufacturers only earned 31% of this spend, while intermediaries earned 69%. An analysis concludes that $339 out of the $425 cost of a box of insulin pens are rebate dollars. PBMs and their paid discount system explain why this 100-year-old drug remains unaffordable for so many people.

By excluding low-reimbursement drugs from formularies, PBMs also systematically prevent patients from accessing the drugs they need. The three largest PBMs block more than 1,150 treatments from forms, including a low-cost insulin alternative called insulin glargine. Patients prescribed these drugs often have to endure long waits, what’s called step therapy (where insurers force patients to try and fail with formulary drugs first), and much higher expenses. .

Read the full article here.

“PBMs put pharmacies out of business, especially independent retail pharmacies.

“4% of all independent retail pharmacies close every year. This will create pharma deserts if you will.

“And when that happens, especially in rural areas, then you’re going to… miss out on the most accessible healthcare professionals here in America.

“It’s bad for health care.”

Listen to Rep. Carter’s full interview here.

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