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Tags: drug prices | lower | pharmacy | managers
OPINION

In Tug of War Over Lower Drug Prices, Pharmacy Managers Pull for Us

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(Roman Didkivskiy/Dreamstime.com)

Jared Whitley By Wednesday, 08 February 2023 05:27 PM EST Current | Bio | Archive

An industry that reduces our drug costs and improves patient outcomes should not be controversial. So why is there a fight against them?

That's the question members of Congress must ask when they begin considering the Pharmacy Benefit Manager Transparency Act. Sponsored by Washington's "progressive" Sen. Maria Cantwell, the bill is a tool of the drug companies that don't want lower drug costs.

As soon as the Senate Commerce Committee considers this legislation, Republicans must reject it.

At the bill's heart is a tug of war with drug companies and pharmacies on one side and patients and Pharmacy Benefit Managers (PBMs) on the other. While not many people have heard of PBMs, almost everyone relies on them as they negotiate drug discounts and contracts with pharmacies on behalf of governments, employers, unions, and health plans.

Anyone with some form of insurance doubtless has a PBM working on their behalf to reduce drug costs and review prescriptions to make sure they're safe. PBMs save $1,000 in healthcare costs per person per year, according to one study, and coordinate prescriptions to prevent some 480,000 heart failures that could have potentially occurred through harmful drug interactions.

A further benefit that PBMs provide, which independent pharmacies want to sabotage, is the direct delivery of drugs. Sending medicine to people's homes has proven to be a winning strategy for patients, especially if they have mobility issues from injury or age.

Home delivery is less expensive and also improves drug adherence significantly, as the patient can't forget to pick up refills that are automatically delivered to their home.

But independent pharmacists do not get to take their cut when this happens, so they want to ban — or at least limit — home delivery. Home delivery saves about $13.7 billion in medical expenses per annum because of improved adherence, which is money that independent pharmacists would prefer to not pass along to the consumer.

PBMs have been cast as a greedy, needless middleman in a sales exchange, kind of like an overpaid real estate agent who cuts a huge commission out of our profit from a home sale. But it's more accurate to view PBMs as our advocates in a legal setting.

Our lawyer is the middleman between us and a bad verdict — does anyone think they could get a better outcome without a lawyer to protect us?

And the explicit intent of the PBM Transparency Act is to limit the ability of PBMs to keep healthcare costs lower for their clients. In the name of fighting "unfair and deceptive" acts, the bill grants the Federal Trade Commission unbridled authority over the drug supply chain.

Not only is this harmful to the future affordability of the healthcare industry, it sets a dangerous precedent for the FTC to regulate prices and business practices in virtually any industry.

In an odd twist, some Republicans supported a similar bill during a committee vote last year even though the legislation includes policies Republicans should hate — like granting the federal government power to overregulate private industry and increase consumer costs.

Not all Republicans have embraced this legislation. When the Senate Commerce Committee voted on a similar bill last year, seven conservative Republicans stood up to defend the private market from this big government overreach in the name of affordability: Cynthia Lummis, Rick Scott, Ron Johnson, Mike Lee, Todd Young, Marsha Blackburn, and Ted Cruz.

Cruz has become the ranking Republican on the committee this year, and he clearly understands that neutering PBMs is not the type of healthcare agenda Republicans should embrace. Conservatives need to dig in their heels to pull for patients, not against them.

Jared Whitley is a longtime politico who has worked in the U.S. Congress, White House and defense industry. He is an award-winning writer, having won best blogger in the state from the Utah Society of Professional Journalists (2018) and best columnist from Best of the West (2016). He earned his MBA from Hult International Business School in Dubai. Read Jared Whitley's reports — More Here.

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JaredWhitley
As soon as the Senate Commerce Committee considers the Pharmacy Benefit Manager Transparency Act, Republicans must reject it.
drug prices, lower, pharmacy, managers
669
2023-27-08
Wednesday, 08 February 2023 05:27 PM
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