U.S. Rep. Buddy Carter, R-GA, is seeking to educate his peers in Congress 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. Monday, he announced the “Pulling Back the Curtains on PBMs” report, an initiative he says will provide the much-needed information.
Carter says this initiative focuses on those at the heart of the problem – those people who are battling PBMs for access to basic treatments and prescriptions. Carter hopes that by highlighting their stories and getting those stories in front of Congress he can put a face to the “often-obscure role” PBMs play in creating barriers to medically necessary treatments and care. Carter, patient advocates, and healthcare providers believe this will help convince members Congress to work to “rein in PBMs.”
“We’re calling for action,” said 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.”
Several groups expressed their support for Carter’s initiative, including the Alliance for Transparent and Affordable Prescriptions, Coalition for PBM Reform and the Community Oncology Alliance.
“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.
Ted Okon, Executive Director of the Community Oncology Alliance, added: 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. 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.”
A number of patients were also interviewed for the project.
“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.
