Cantwell: “It’s too much concentration of power, not enough transparency, and not enough policemen on the beat”
SEATTLE, WA – Today,U.S.Sen. Maria Cantwell (D-WA) and U.S. Rep. Kim Schrier (D-WA-8) were joined by local pharmacists, industry stakeholders, and others affected by skyrocketing costs of medications in Seattle for a roundtable discussion and press conference to advocate for legislation that would lower prescription drug costs. Sen. Cantwell also highlighted her bipartisan bill that would hold pharmacy benefit managers (PBMs) accountable for their unfair and deceptive practices.
“Everybody knows that drug pricing is way too high. What people don’t understand is that someone who now controls about 80 percent of the market – three companies — are impacting that by using unfair and deceptive practices,” Sen. Cantwell said. “The pharmacists that are here today who advocated on behalf of our delivery system have made it clear: They can’t continue to exist or do business if these kinds of profit centers end up controlling the marketplace.
“Pharmacy benefit managers — who basically negotiate big discounts but keep all the discounts, or most of the discounts – are not helping us lower drug pricing,” Sen. Cantwell continued. “It’s too much concentration of power, not enough transparency, and not enough policemen on the beat calling out unfair and deceptive practices.”
Said Rep. Schrier: “This something that’s been on my mind for a long time as many of you know, because I have Type I diabetes and I’ve seen the cost of insulin skyrocket from about $40 a bottle to now up north of $300 a bottle for no reason — and with a medicine that costs about $10 to produce. This is a manipulated market … Nobody should have to choose between paying for their medication and putting food on the table.”
Sen. Cantwell introduced the bipartisan Pharmacy Benefit Manager Transparency Act of 2022 in May. The bill would ban unfair pricing schemes, prohibit arbitrary “clawbacks” of payments made to pharmacies, and require PBMs to report to the FTC how much money they make through spread pricing and pharmacy fees. The bill advanced out of committee last week, and the next step is the full Senate for consideration. Senator Cantwell introduced similar legislation in 2021 to empower the FTC to conduct a study into whether PBMs provide actual value to the drug distribution chain, and whether PBMs are engaging in anticompetitive behavior leading to increased costs for consumers.
PBMs were initially formed in the 1960’s to process claims and negotiate lower drug prices with manufacturers. Now, PBMs administer prescription drug plans for hundreds of millions of Americans, and three PBMs control nearly 80% of the prescription drug market. They serve as middlemen, managing every aspect of the prescription drug benefits process for health insurance companies, self-insured employers, unions and government programs.
PBMs operate out of the view of regulators and consumers — setting prescription costs, deciding what drugs are covered by insurance plans and how they’re dispensed — and pocket unknown sums that might otherwise be passed along as savings to consumers, undercutting local independent pharmacies. This lack of transparency makes it impossible to fully understand if and how PBMs might be manipulating the prescription drug market to increase profits and drive up drug costs for consumers.
Text of the Pharmacy Benefit Manager Transparency Act of 2022 is available HERE. Section-by-section HERE.
“Pharmacy benefit managers are the Goliaths of health care. They own the pharmacies, the specialty pharmacies, mail order pharmacies. They own health clinics as well as the health carriers. They have lost track of what they were designed to do. And instead of designing formularies to optimize patient outcomes, they have gotten to the point where they are just optimizing shareholder profits, and they need regulations introduced to really get back to basics and to optimize patient outcomes,” said Jenny Arnold, CEO of the Washington State Pharmacy Association.
“This particular practice from pharmacy benefit managers– when it comes to dictating the price of medication, dictating how medication will get to patients, which kind of medication will be accessible to patients – the group or community that’s most impacted continues to be the marginalized community,” said pharmacist and State Rep. My-Linh Thai (D-Bellevue). “Standing here as a state representative who cares deeply about our health care system, I want to make sure that we continue this line of work in collaboration between state and federal, with really the focus on patient safety and ensuring that our health care delivery system continues to be patient-centered.”
“PBM business practices represent a real threat to patient access to care,” said Ryan Oftebro, President of the Washington State Pharmacy Association. “What we see happening on a daily basis is that PBMs, through their business practices, are creating barriers to care and access by making medications more expensive than they should be. We see seniors who are paying more out of pocket for generic medications than they need to, with that money going direcly back to the PBMs, and it’s impacting pharmacies’ ability to remain viable and serving our communities.”
Video from today’s event is available HERE, audio HERE, and a full transcript HERE.
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