Problematic Pharmacy Benefit Managers

Time for Congress to Reform Pharmacy Benefit Managers

For myself and many others in my community, it feels like we have no transparency or guidance when trying to access quality treatments. Too often, when picking up a prescription from the pharmacy, we can be hit with outrageous out-of-pocket expenses and refill bills. I was disappointed to find out that some of this traces back to pharmacy benefit managers (PBMs), who are intermediaries between drug manufacturers, providers, and pharmacies. While PBMs claim to lower costs for customers, they keep a large share of savings intended for patients in efforts to boost their bottom line, even if it makes it more difficult for people to receive life-saving medications.

 I’m grateful some of California’s leaders have made their voices heard on this issue, including Rep. Nanette Barragán and her introduction of the bipartisan HELP Copays Act. This legislation will help protect patients and could prevent PBMs from carrying out schemes that leave us with higher costs on necessary treatments.

 After the federal August recess, I hope Sen. Padilla and other leaders in California’s Congressional Delegation will recognize the brave work of their colleague and sign onto this act so that everyone can receive the savings they’re entitled to at the pharmacy counter.

 Alan Escobar

San Pedro

More on Pharmacy Benefit Managers

It is difficult enough for patients to navigate our healthcare system and afford the high costs of care without the profit-driven practices of insurance companies and their Pharmacy Benefit Managers (PBMs) making things exponentially worse. Congress should do something to hold these shadowy groups more accountable for the so-called business practices they use to drive up profits while threatening access and affordability for vulnerable patients.

Our family has unfortunately been on the receiving end of these harmful practices, with my uncle recently recovered from a stroke on top of living with diabetes. Broken PBM policies make it more difficult for him and millions of other patients to access the care and treatments they need to stay healthy and improve their quality of life.

It shouldn’t be this way, but unfortunately PBMs have been able to avoid government oversight for far too long, allowing them to dictate precisely where and when patients can access certain medications through policies like prior authorization and patient steering. While prior authorization can lead to lengthy delays in accessing physician-prescribed medications, therapies and treatments, patient steering puts up additional barriers to care for patients by limiting access to vital prescriptions to the pharmacies owned by or affiliated with PBMs.

Even more shocking is the fact that, as the healthcare middlemen working between drug manufacturers and pharmacies, PBMs will negotiate with manufacturers to secure rebates and discounts on prescriptions, which are intended to be shared with patients to help reduce out-of-pocket expenses at the pharmacy checkout line. However, PBMs will almost always find ways to withhold those savings, simply absorbing them to inflate their profit margins instead. That leaves millions of vulnerable Americans on the hook for higher out-of-pocket costs.

To me, that’s a sign of a broken healthcare system. Fortunately, there is legislation in Congress that could help address this issue. The bipartisan Help Ensure Lower Patient (HELP) Copays Act, which has been introduced in both the Senate and the House, would rein in and reform PBMs, bringing some much-needed oversight and accountability over these groups and practices they use to maximize profits while driving up costs and undermining access for patients.

As someone who has seen firsthand the negative impact PBMs have on prescription drug access and affordability, I’m grateful to Representative Nanette Barragán for cosponsoring the HELP Copays Act in the House and hopeful that she and the rest of California’s congressional delegation will help ensure Congress passes this much-needed legislation without delay.

Luis Rodriguez

Lynwood