OPINION: It’s time for Congress to protect patients by passing meaningful PBM reform

As someone living with a myriad of chronic health conditions, including type 2 diabetes, high blood pressure, high cholesterol, and most recently, restrictive lung disease, I’m aware of the uphill battle patients face when it comes to accessing vital medications. It’s a battle that shouldn’t exist, yet it persists due to the harmful practices of Pharmacy Benefit Managers (PBMs) and insurers. The time for meaningful reform is long overdue, and Congress must act now to alleviate the burden on patients.

Patients have a lot to be discouraged by as lawmakers continue to falter in passing legislation that could shield patients from PBM abuse. Meanwhile, patients like me are left grappling with the consequences of PBM policies that dictate when, where, and how much we pay for vital medications. These practices not only hinder timely access to care but could also worsen many patients’ health issues, leading to detrimental outcomes. It took five months to get my diagnosis due to my insurance company requirements for appointments. This wastes valuable time, especially with progressing diseases. Now that I have my diagnosis, I am forced to wait months to see a specialist. 

A glaring lack of accountability plagues PBMs, allowing these middlemen to exploit the best parts of our healthcare system, including manufacturer rebates and the 340B drug discount program. Instead of passing savings on to patients, PBMs prioritize profit margins and leave vulnerable patients with exorbitant out-of-pocket expenses. It’s a disheartening reality that at-risk patients must pay more for life-saving medications while PBMs line their pockets.

The urgency for reform cannot be overstated. Patients should not be at the mercy of profit-driven middlemen whose actions impede access to essential healthcare. Congress must prioritize the well-being of its constituents by championing legislation that addresses the root causes of these issues.

The DRUG Act is a crucial step in the right direction. This legislation aims to dismantle barriers to care and alleviate the burden on patients by delinking PBM profits from list prices and promoting greater transparency. It’s a beacon of hope for Nevadans who have felt the weight of unfair PBM practices for far too long.

Support for the DRUG Act is not just a matter of policy; it’s about standing up for patients who are often overlooked in the current healthcare system. As a patient who understands firsthand the challenges posed by PBM practices, I urge our lawmakers to take decisive action. The time for excuses and half-measures has passed. Congress must seize this opportunity to enact meaningful reform and safeguard patients’ access to care.

Patients in Nevada deserve access to the medications we rely on without facing unnecessary hurdles imposed by PBMs and insurers. As we continue to navigate the complexities of our healthcare system, it is imperative that Congress listens to the voices of patients and acts swiftly to enact meaningful reform.