Two members of Georgia’s Republican congressional delegation are fighting to break up what they call a Pharmacy Benefit Managers monopoly. U.S. Reps. Buddy Carter and Rick Allen led a group of bipartisan members of Congress late last week in introducing the PBM Reform Act, which they said protects patients and pharmacies from the harmful and anticompetitive business practices of pharmacy benefit managers (PBM).
“It’s time to bust up the PBM monopoly, which has been stealing hope and health from patients for decades. As a pharmacist, I’ve seen how PBMs abuse patients firsthand, and believe that the cure to this infectious disease is transparency, competition, and accountability, which is exactly what our bipartisan package provides,” said Carter.
According to Carter, PBMs were created as middlemen to reduce administrative costs for insurers, validate a patient’s eligibility, administer plan benefits, and negotiate costs between pharmacies and health plans. “Over time, PBMs have been allowed to operate virtually unchecked as they consolidated to where three companies now control 80 percent of the prescription drug market.”
He went on to say that “vertical integration and a lack of transparency have led to pharmacy closures and higher costs for patients across the country. The PBM Reform Act will:
● Ban “spread pricing” in Medicaid and move to a transparent system that ensures pharmacies are fairly and adequately reimbursed for serving Medicaid beneficiaries.
● Establish new requirements for PBMs under Medicare Part D, including a policy to delink PBM compensation from the cost of medications and increase transparency.
● Promote transparency for both employers and patients in their prescription drug plans, with semi-annual reporting on drug spending, rebates, and formulary determinations.
● Require Centers for Medicare and Medicaid Services (CMS) to define and enforce “reasonable and relevant” contract terms in Medicare Part D pharmacy contracts and enforce oversight on reported violations.
“PBM reform has long been a pressing issue, not only in rural Georgia, but across the nation,” said Rep. Allen. “I am proud to work with Representative Carter on this commonsense package to eliminate the use of spread pricing, make prescription drugs more affordable, and establish rigorous oversight over PBM tactics that threaten access to care. Our health care system is in need of patient-centered, cost-effective, market-driven solutions and this package delivers.”
