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The Biotechnology Innovation Organization (BIO) and patient advocacy organizations have seen some recent progress in their efforts to have Congress pass pharmacy benefit manager (PBM) reform.
In the midst of BIO’s BIOAction campaign to push for PBM reform, several patient groups are weighing in on how PBMs hurt patients and the need for policy to address these companies.
Why are we talking about PBMs?
The six largest PBMs control almost 96 percent of the PBM market. Furthermore, of the six PBMs, three of them—CVS Caremark, Express Scripts, and OptumRx—control 80 percent of that market.
“This gives PBMs inordinate power to set prices, deny coverage and pad their bottom line instead of passing the savings along to people who need medicine,” says BIO.
Pushing for PBM reform
Several organizations are urging action on PBMs. In July, a coalition of almost 2,000 businesses, employers, patient advocates, pharmacies, and providers sent a letter to Congress advocating for PBM reform. This effort was led by FMI – The Food Industry Association and the National Community Pharmacists Association. Signatories included the AIDS Healthcare Foundation, the Alliance for Pharmacy Compounding, the American Pharmacists Association, the National Association of Chain Drug Stores, and the National Association of Specialty Pharmacy.
More recently, in November, 109 patient and provider organizations sent a letter to congressional leadership urging the passage of comprehensive PBM reform legislation. These organizations are asking that the Safe Step Act (S. 652/H.R. 2630) be included in the final package. Among the signatories to this letter are the National Psoriasis Foundation, the Arthritis Foundation, Color of Crohn’s and Chronic Illness, the Georgia AIDS Coalition, the HIV + Hepatitis Policy Institute, ICAN – the International Cancer Advocacy Network, the Multiple Sclerosis Foundation, the San Francisco AIDS Foundation, and The Michael J. Fox Foundation for Parkinson’s Research, to name a few.
Other organizations, such as the AIDS Healthcare Foundation and the California Medical Association, have also been pushing for PBM reform.
House and Senate advance PBM legislation
On November 15, the House Energy & Commerce Health Subcommittee advanced 21 health-related bills, including bipartisan legislation to check abuses by PBMs.
The PBM legislation approved included:
- H.R. 2880, the Protecting Patients Against PBM Abuses Act;
- H.R. 5393, which addresses PBM fees; and,
- H.R. 5385, the Medicare PBM Accountability Act.
Earlier this month, the Senate Finance Committee advanced the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, which includes the Modernizing and Ensuring PBM Accountability (MEPA) Act. The bill would “rein in the shadowy tactics by pharmacy benefit managers that hurt community pharmacies and drive up prescription drug costs for seniors and taxpayers,” said co-sponsor Senate Finance Chair Ron Wyden (D-OR).
The full House and the Senate must now approve these bills to become law.
Learn how you can contact your Member of Congress or Senator to urge them to pass PBM reform.
