Submitted by Deryl McCarty, USAF (Retired), Puyallup (South Hill), WA.
As one who provides home health care for a family member, it is incredibly frustrating to see the impact that high out-of-pocket prescription costs can have on patients – no, on all of us. It is even more frustrating to know that one of the reasons these expenses have gotten so high is not just because newer medicines have billions in research costs to pay for, but also because of the practices and policies enforced by insurers through their Pharmacy Benefit Managers or PBMs for short.
PBMs control 80% of the prescription drug marketplace, and they use that power to essentially dictate when and where patients can access the doctor-prescribed medications and treatments they need. The disturbing part is that some PBMs will often negotiate with manufacturers to secure vital discounts on prescription drugs, and then simply keep those savings for themselves to inflate profit margins, rather than passing the majority of those discounts and savings along to consumers to help lower out-of-pocket costs at the pharmacy.
Don’t get me wrong. I do not begrudge a PBM getting a good deal for us; in fact, they should get a piece of the action for their negotiation skills. But a 90-10 split – for example – (i.e., 90% of the discount directly applied to patient or taxpayer costs, and 10% to the PBM) when multiplied by a gazillion pills per year probably results in a pretty fair profit for the insurers and PBMs and a much fairer deal for patients.
Congress has very little time left to solve this growing problem. Lawmakers must work together to reform PBMs before the end of the year. The Protecting Patients Against PBM Abuses Act (H.R. 2880) would go a long way in bringing greater transparency and oversight into the shadowy world of PBMs to protect patients and improve access to prescription medications.
Representative Marilyn Strickland (D, Pierce County area) should work with her colleagues on both sides of the aisle, for example, Representative Cathy McMorris Rodgers (R, Spokane Area), Dan Newhouse (R, Yakima/Tri-cities), and Derek Kilmer (D, Olympic Peninsula) to pass this much-needed solution as soon as is humanly possible. Millions of individual patients in Washington and across America are counting on it. But as impactful, and why I chose those four Washington Congressional leaders, is that they each have a large active-duty military and veteran presence in their districts. And while the military generally provides medicines in its own facilities at no cost to the military patient, who would get the benefit of a PBM negotiated discount? We taxpayers.
