The current U.S. Congress has just a few more weeks of work left before it adjourns to make way for newly elected lawmakers. As they finish up their final housekeeping items, there is one remaining promise that senators and representatives have made to the American people that must be kept. Congress must take immediate legislative action to lower prescription drug out-of-pocket costs.
Making drugs more affordable is not a heavy lift on Capitol Hill and is, in fact, not even controversial. There is strong bipartisan support in the Senate and House for measures that will rein in the anti-consumer business practices of pharmacy benefit managers, or PBMs. Committees in both houses have compiled volumes of evidence detailing how PBMs are manipulating the drug pricing system to boost their own profits. Several bills have already cleared congressional committees. The only task remaining is to pass PBM reform legislation and send it to President Biden for his signature before the current Congress’ clock runs out.
Congress can take immediate legislative action to lower prescription drug out-of-pocket costs. (Credit: American Statesman/File)
Texas patients and consumers know firsthand that our prescription drug pricing system is badly broken. It simply isn’t right when PBM middlemen negotiate rebates and discounts with drug manufacturers, pocket those savings as profits and then charge patients co-pays based on the drug’s original list price rather than the lower negotiated price.
But it gets even worse. As a Federal Trade Commission investigation pointed out, PBMs are using their power to steer patients toward more expensive medications – those that generate the greatest profits for the PBMs – while obstructing access to cheaper alternatives like generics and biosimilars. Not only are these large corporations inserting themselves between patients and their physicians in making decisions about medicines, but they are imposing unnecessarily high out-of-pocket costs on drug consumers, many of whom are on fixed incomes.
The problem is well documented. The evidence is substantial. And the damage being done to millions of Americans is extensive and indefensible. Now all we need is for Congress to have the will to fix this dilemma before adjourning.
There are two bills that have been passed by the Senate Finance Committee, the “Modernizing and Ensuring PBM Accountability Act” and the “Better Mental Health Care, Lower-Cost Drugs, and Extenders Act.” Among the provisions in both bills are two that are most critical.
First, it is essential to permanently break the linkage between PBM revenues and the cost of drugs. When PBMs make money from rebates tied to a drug’s list price, the incentives are in place for PBMs to force patients to use higher-priced drugs. PBMs should be paid a flat, fair market-based fee for the services they provide and not maximize their profits by forcing financially strapped families to choose between medicine and groceries.
Second, those rebates that the PBMs negotiate with the drug companies? They should be passed along to patients at the pharmacy counter and not diverted into PBM quarterly earnings. It is unconscionable for consumers to pay full price for a drug that PBMs are getting at a discount.
These are common-sense measures that are neither Republican nor Democratic ideas. They have the strong support of lawmakers in both parties. The clock is ticking, though. We have just a short time remaining before the current Congress ends. If this work is not completed, the next Congress would have to start from scratch and patients’ health and finances will continue to be damaged at the hands of multibillion-dollar PBMs.
We encourage the Texas congressional delegation, and all of Congress, to make PBM reform a foremost priority. Don’t leave Washington, D.C., this year without making prescription drugs more affordable by passing these measures.
Ford is president and CEO of the Texas Healthcare & Bioscience Institute.
This article originally appeared on Austin American-Statesman: Time is short for Congress to lower prescription drug costs | Opinion
