SAVANNAH, GA – Rep. Earl L. "Buddy" Carter (R-GA) today announced the “Pulling Back the Curtains on PBMs” report, an initiative to educate Members of Congress and the public on the role pharmacy benefit managers (PBMs), the pharmaceutical industry’s middlemen, play in driving up costs for medications, delaying necessary treatments for patients, and robbing hope from their loved ones.
This initiative focuses on the people at the heart of the problem, who are battling PBMs for access to basic treatments and prescriptions. By highlighting their stories and getting those stories in front of Members of Congress who can rein in PBMs, Rep. Carter, patient advocates, and healthcare providers hope to put a face to the often-obscure role PBMs play in creating barriers to medically-necessary treatments and care.
Watch and read their stories here.
"We’re calling for action,” said Rep. Carter. “PBMs have been allowed to rob patients blind for decades and Congress cannot afford to continue ignoring a system that is forcing our loved ones to stay sick, sacrifice their mental health, go into debt, and put their lives on hold just to convince a man behind a computer that they need the care their doctor says that they do. I’m a pharmacist, I’ve seen this firsthand. Congress can attack the drug manufacturers all they want, but here’s the truth: until PBMs are reined in, nothing is going to change."
"Every day across America, millions of real patients with chronic disease are forced to deal with the policies of PBMs, the self-interested gatekeepers of patient care, determining what pharmacies, medications, and therapies patients can access, despite what their doctors prescribe. PBMs have continued to line their own pockets with the rebates intended for patients at the pharmacy counter, creating a healthcare ecosystem that puts PBMs at the center, not patients. It’s far past time these practices are exposed for what they are - profiteering off America’s sickest," said Terry Wilcox, CEO and Founder of Patients Rising Now.
"PBMs have delayed my therapy and changed the order of my treatments, not because it was better for my health, but because it was better for their bottom lines. The stress of battling the healthcare industry for basic care is costing me time, money, and mental energy, all of which negatively impact my health. The worst part of having Crohn’s Disease should not be fighting PBMs, but at times, it is," said Jessica Wofford, a patient interviewed for this project.
"It’s a scary time to be a patient in America. PBM boardrooms have taken over the doctor-patient relationship and sacrificed patient well-being on the altar of financial gain - I call it hijacked healthcare. Instead of decisions about my care being dictated by which treatment is best for me medically, my care plans are determined by which monkey-math spreadsheet pads the PBM’s pocket the most. As a patient, being trapped in this funny-money war is often worse than the physical diagnosis itself," said Elisa Comer, a patient interviewed for this project.
Several groups expressed their support for Rep. Carter’s initiative:
“Currently, 8 in 10 Americans say prescription drug prices are too high. Pharmacy Benefit Managers have dominated the prescription drug market for years, creating a system that prioritizes profits over life-saving medications. Our organizations represent hundreds of thousands of employers, healthcare providers, and patients whose access to medications is threatened each day by a handful of companies that have been able to operate for far too long with little or no scrutiny. We applaud Congressman Buddy Carter for shedding light on the harmful effects of PBMs.” - Coalition for PBM Reform
"The top PBMs have a stranglehold on the prescription drug market, coming between patients and their doctors, causing unnecessary suffering by delaying, denying, and obstructing care. As a result, patients with cancer and other serious diseases more often don’t get the treatments they need and end up paying more for their drugs," said Ted Okon, executive director of the Community Oncology Alliance. "Members of Congress and government regulators need to ask themselves: 'If you or a loved one faced cancer, would you want a PBM obstructing your care?' The obvious 'no' answer is why PBMs must be stopped."
"I have been HIV positive for 17 years. My pharmacist is a major reason I have remained healthy during that time. My pharmacist knows me and knows what is best for me. If I couldn’t speak to her or ask questions, I’d lose out on a valuable connection for my healthcare. PBMs fail to understand the importance of this relationship folks like me have with their pharmacist. Their selfish efforts that focus solely on profits is at the detriment of people living with HIV. We need our direct connections to our neighborhood independent pharmacies - they are a lifeline for many of us," said John Farina, Associate Director of Advocacy - Social Media Platforms for AIDS Healthcare Foundation.
"PBMs continue to jeopardize the affordable access to medications and the treatments that Georgians need to stay alive, reach their maximum wellness and remain productive to their employers, families and communities. It is time for our legislators to act now and pass laws to provide robust oversight of PBMs, transparency in drug pricing and protections for patients from PBM egregious practices; all enormously increasing overall healthcare costs. We will have a healthier prescription market when we rein in the PBM middlemen profiteers and leave the practice of medicine to the medical professionals," said Dorothy Leone-Glasser, Executive Director of Advocates for Responsible Care (ARxC) and the Project Chair of the Rx in Reach GA Coalition.
"PBMs are the healthcare industry's middlemen responsible for negotiating drug prices and establishing an insurer's formulary or list of drugs covered. What Americans may not realize is that PBMs receive large discounts or rebates in exchange for placement on an insurer's formulary, and there is no expectation that PBMs disclose these rebates or pass the savings on to patients. PBMs’ role in healthcare is supposed to unlock value and cost-savings. However, in practice, PBM policies are fostering many of the issues that plague the US healthcare system," said Brian Nyquist, Executive Director of Infusion Access Foundation.
"The Autoimmune Association works with Congress to advocate for transparency on the practices of pharmacy benefit managers. We are hopeful that PBMs will begin to understand how some of their protocols impact the patient community. We are proud to have co-led a sign-on letter to the FTC highlighting how PBM practices hurt patient care and fuel higher costs," said Quardricos Driskell, Vice President of Public Policy and Government Affairs for the Autoimmune Association.
"Formulary design decisions are driven not by what’s best for patients, but by what’s best for the PBM’s bottom line. Once the formulary is set for a contract year, the PBM leverages aggressive utilization management to drive patients to the product most profitable for itself. This approach interferes with clinical care and the doctor-patient relationship. Our drug pricing system will remain broken until these perverse incentives are fixed," said Dr. Robert Levin, President of Alliance for Transparent and Affordable Prescriptions.
“PBMs negotiate with drug companies for rebates, discounts, and other price concessions, and in exchange the drug companies receive preferred formulary placement. The drugs that provide the biggest revenue potential for the PBM gain the best spots on formulary. The PBM will then use aggressive utilization management tools to drive patients towards those drugs. Since a drug’s list price must be high so as to offer 'headroom' for these payments to the PBM, high drug prices are not a mere byproduct of this system – they are at the heart of its design," said Madelaine A. Feldman, M.D. FACR, Vice President of Advocacy and Government Affairs for Coalition of State Rheumatology Organizations.
Read the full report and watch patient testimonials here.
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