I hope this letter finds you well. I am a constituent of yours and I am writing to express my concern regarding the opaque operations of pharmacy benefit managers (PBMs) and to urge you to support House Bill 1627 and Senate Bills 843 and 1105 that seek to enhance transparency in their dealings with patients and health care providers.
Initially PBMs played a crucial role in our health care system by serving as intermediaries between drug manufacturers, health insurance companies, pharmacies, and patients. While they purported to help contain and reduce prescription drug costs, there is now overwhelming evidence about their lack of transparency, which often results in patients not receiving the medication their doctor initially prescribed and are the cause of price increases for medications.
Amid heightened scrutiny surrounding the contentious role these companies play in the U.S. pharmaceutical supply chain, the U.S. Federal Trade Commission is boldly reversing years of prior advocacy in support of PBMs.
Many patients, including some of my close family members and friends, have experienced difficulties due to the continuous uptick in drug prices, challenges with prior authorization processes, and the mysterious "clawback" practices. Such experiences are not only financially burdensome but also affect their health due to unnecessary delays and confusion.
Congress is attempting to address high drug prices, this time by focusing on pharmacy benefit managers (PBMs) in a bipartisan fashion. Our legislation mirrors many of their key reform measures including;
1. Transparency
a. Purchasers receive the rebates drug manufacturers provide to reduce costs.
b. Covered drugs should be a clinical decision, not which drug produces the largest profit for PBM’s. Health care providers have a clearer understanding of drug formularies and can thus make better-informed decisions for their patients.
2. Spread Pricing
a. Ensure plans and patients know what they are being charged by the PBM versus what the PBM pays to the pharmacy.
3. Rebate Pass-Through
a. Rebates from manufacturers are meant to lower drug costs to patients and plan sponsors, not increase prices so manufacturers can pay larger rebates to PBM’s to pocket and divert away from patient and plan sponsor discounts.
I kindly request you support HB 1627, SB 843, and SB 1105. Our community deserves affordable and understandable health care. Addressing PBM practices is a crucial step in that direction.
Thank you for your time and consideration. I trust that you will keep the best interests of Missourians at heart as you deliberate on this matter.
