I am writing to express my deep concern about the negative impact that Pharmacy Benefit Managers (PBMs) have on my business and patient care. As a practicing pharmacist, I have witnessed firsthand how these PBMs are undermining the health care system and making it more difficult for patients to access necessary medication. An estimated 18 million can’t afford the prescription drugs they need.
As you are aware, the high cost of prescription drugs is a bipartisan issue with many looking for who is to blame. As the U.S. Federal Trade Commission (FTC) and the Department of Justice have launched investigations into PBMs and their Rebate Aggregators, it is now apparent that PBMs need stronger transparency requirements.
PBMs were created in the 1960s to help health insurance plans control spending on prescription drugs. PBMs negotiate upfront discounts on the prices of prescription drugs with pharmaceutical manufacturers which reward favorable coverage of a particular drug and the resulting increase in utilization by a health plan’s patients. Rebate Aggregators negotiate rebates with drug manufacturers on behalf of PBMs or plan sponsors and hold the contracts governing these rebates. These agreements have been kept secret with little to no government oversight, so it is unclear what amount is reaching pharmacists and our patients.
What is clear is that prescription drug costs are rising for your constituents. A 2021 study discovered that drug manufacturers providing rebates to PBMs and insurers can lead to higher out-of-pocket costs for patients, averaging $6 more per prescription for people with private insurance, $13 for Medicare, and $39 for the uninsured.
The negative effects of PBMs extend far beyond rising drug costs. Their below cost reimbursements force many independent pharmacists out of business. This undoubtedly has a devastating impact on small businesses which are already struggling to stay afloat.
As a pharmacist, I am committed to providing the best possible care to my patients, but the current PBM system is making it impossible. I strongly believe that legislation is necessary to promote more transparency and accountability for these PBMs. Thank you for considering the harmful effects of PBMs on businesses and patients alike. Your advocacy and support are integral to help ensure that patients have affordable access to the medications they need and that your local pharmacies can continue to serve them.
