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PBM's negotiate rebates on medicine. (Photo: Shutterstock)

The Shady Middlemen Putting Profits Ahead Of Patients

Pharmacy Benefit Managers control 80 percent of patients’ medicine

By Luke Perry, September 27, 2022 12:04 pm

Over the next couple months, leading up to the midterm elections, we should expect to hear more and more from our lawmakers and prospective candidates. I know I’m not alone in feeling like the campaign ads have been nonstop. 

As a recent author pointed out, incumbent candidate Senator Cortez Masto has been promoting the partisan Medicare negotiation bill that just passed in Washington D.C. What the author and the Senator failed to discuss in detail, were the implications this bill could have on access to new treatments over the coming decades. 

I think everyone can agree that out of pocket costs for patients need to come down, but expanding the authority of politicians who know nothing about the market doesn’t offer me additional comfort. I trust scientists and doctors, not lawmakers as experts on how research and development for new medications could be impacted. Because of this short-sighted move, Nevadans could lose out on a dozen new medicines – something I’m sure we’ll hear very little about on the campaign trail. 

I wish instead our lawmakers could have worked across the aisle and included provisions in the reconciliation bill that brought oversight into the practices of Pharmacy Benefit Managers (PBMs). Republicans and Democrats agree that these middlemen pocket savings that are intended for people who pick up their prescriptions at the pharmacy counter. 

The issue with PBMs is that, more often than not, they’re the entity deciding what medicines are covered by your insurance, what medicines aren’t covered, and what you pay for them at the pharmacy. According to a recent study, more than half of every dollar spent on medicines went to payers, middlemen, providers, and other stakeholders in the last few years. 

Even more alarming, just three insurance company PBMs control 80% of patients’ medicine. They’ve had a runaway to do whatever they want with pricing for years now and it’s long past time to turn the lights on these shady middlemen putting profits before patients. 

At the end of the day, driving down costs or protecting innovation is a false choice for patients. It makes no sense why the reconciliation package did not include oversight into insurance practices or reforms around PBMs. 

In future votes, our candidates and elected lawmakers should focus on proposals that protect patients, fix our country’s broken system, and support medical innovation. Rushing through legislation thousands of miles away from Nevada leaves vulnerable patients and families behind. I’m calling on Congress to do their part to ensure Medicare negotiation doesn’t do the damage to patient access or research evidence suggests it will. Listen to patients – put people over politics and patients over profits. 

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