Policy and Legal

Pharmacy benefit managers are driving up health care costs for employers and employees alike—and they must be reformed as soon as possible, Rep. Buddy Carter (R-GA), Sen. James Lankford (R-OK) and other members of Congress said at a bicameral, bipartisan Capitol Hill press conference Wednesday.

What’s going on: Rep. Carter, Sen. Lankford and other lawmakers—including Reps. Mariannette Miller-Meeks (R-IA), Raja Krishnamoorthi (D-IL) and Nanette Barragan (D-CA)—are calling on House and Senate leadership to advance PBM reform legislation in Congress’ year-end lame-duck session.

• The House passed a bipartisan PBM reform bill last December, and seven congressional committees—in both the House and Senate—have approved PBM bills during this Congress.
• The NAM, long a champion of commonsense PBM reform, offered manufacturers’ strong support for the lawmakers’ efforts.

What they said: “Democrats and Republicans [alike] … recognize that PBMs are decreasing the accessibility, the affordability and therefore the quality of health care in America,” said Rep. Carter, who showed the crowd photos of real patients facing difficulties accessing medications due to PBMs.

• “Congress must act before the end of the year to save our constituents’ lives. That’s why I’m leading a bipartisan letter to the House and Senate leadership urging them to prioritize PBM reform during end-of-year negotiations and ensure that the bipartisan efforts we have worked on through the 118th Congress are enacted into law.”
• Added Rep. Miller-Meeks, sponsor of the NAM-backed DRUG Act: “Every American who utilizes prescription medications experiences the impact that PBMs … have on our health care system. Patients everywhere—and our independent pharmacists—deserve a health care system where patients always come first.”

Why it’s important: PBMs often dictate the prices that patients pay at the pharmacy counter—and their business model incentivizes them to increase those prices for their own benefit.

• PBMs take a cut of a drug’s list price and pocket a large portion of rebate savings that are supposed to go back to patients and employers.
• In addition, they operate without transparency into their pricing decisions, making it more difficult for employers to reduce prices or access savings.

Now’s the time: “We want leadership to be able to take [PBM reform legislation] up in the end-of-the-year package,” Sen. Lankford said at the press conference. “We don’t want to tell … patients, ‘Wait another two years and maybe we’ll get into it in the next session.’ Let’s actually get into it in this session.”  

NAM advocacy: The NAM has been at the forefront of the fight for PBM reform. Last month, it launched a seven-figure ad campaign urging the passage of reforms during the lame-duck session.    

The last word: “Manufacturers and manufacturing workers are facing increasing and unsustainable health care costs as a direct result of PBMs,” said NAM Managing Vice President of Policy Chris Netram. “Manufacturers agree with Rep. Carter and the bipartisan, bicameral members of Congress calling for reform: Congress must act urgently—in the lame-duck session—to increase transparency, lower health care costs and protect manufacturing workers.”