The House Committee on Oversight and Accountability on Tuesday will conduct a hearing evaluating the transparency and accountability surrounding pharmacy benefit managers (PBMs). The hearing is set to "examine how PBMs have used their position as middlemen to cement anticompetitive policies which have increased prescription drug costs, hurt independent pharmacies, and harmed patient care."
The Committee includes three members of Florida's congressional delegation — U.S. Reps. Byron Donalds, Anna Paulina Luna and Mike Waltz.
The meeting indicates Congress will be taking the issue up in the near future, with Committee Chair James Comer of Kentucky writing in a statement that the committee has already "sounded the alarm over anticompetitive tactics" by PBMs and their "role in rising drug prices."
But while PBMs have caught a bad rap in recently years — decried as middlemen responsible for overcharges on prescription medications, driving up costs for consumers and squeezing out the little guy — there's another side that suggests otherwise. That is, PBMs are actually good for employers and can offer saving to employees, according to industry professionals.
"Across the state, Florida employers are facing the challenge of rising health care costs," Florida State Hispanic Chamber of Commerce President Julio Fuentes told Florida Politics.
"By negotiating lower prices for prescription drugs and offering cost-effective pharmacy options, pharmacy benefit managers help Florida employers reduce their costs. These savings, an average of $1,040 per employee annually, can be the difference between a business thriving and struggling to stay afloat."
He cited a report from the Pharmaceutical Care Management Association, which represents PBMs. It claims PBMs not only save patients money by negotiating lower costs, they also are "committed to working with pharmacies to support patients' access to prescription drugs."
The report cites activity in rural communities that "are offering innovative programs to support increasing pharmacy reimbursements," including "expanding reimbursements for clinical services performed at rural independent pharmacies for rural patients."
And Fuentes is not alone. Rick Van Warner, the former CEO of Tijuana Flats, said in an op-ed for Florida's Voice that "pharmacy benefit companies consistently help provide plan sponsors and their employees with critical savings and flexibility to better access" prescription medications.
"Given the skyrocketing cost of prescription drugs nationwide, it's abundantly clear that pharmacy benefit companies are a vital resource in helping employees and families more affordably access the medications they desperately need," he wrote.
A retired pharmacist who worked both as an independent pharmacist at a small pharmacy in Quincy and as a corporate pharmacist offered similar praise, as well as caution against overregulating or eliminating PBMs.
In an op-ed for The Capitolist, Lynn Massey laid out benefits to patient care and for pharmacies.
For pharmacies, which critics claim will be hurt by continued "middlemen" interference, Massey wrote that PBMs provide value by collecting "data by region and help pharmacies like myself make business decisions on programs for my patients."
As an example, she said such data "would tell me that my community had the highest diabetic population in North Florida," information that would allow her "to explore ideas and programs that would be a real benefit to my patients."
And on patient care, Massey said PBMs "prevent cost increases for employers and patients by negotiating against the big drug companies." But she said it's more than just cost savings. "PBMs have also taken on an increased responsibility with individual patient care," she said, adding that could be through medication reminders or house visits or check-in calls.
"PBMs help identify the best way to access specialized treatments for patients with chronic conditions and seniors," Massey wrote. "For many patients with complicated medication regimens, PBMs help manage the patient's day-to-day needs to avoid potential complications."
Hers was a scathing rebuke on what she described as "misguided attacks" led by "big drug companies that would profit if PBMs were less effective."
And there's plenty more where that commentary comes from. The Alabama Political Reporter last month reported that "dozens" of employers had signed onto a letter to its congressional delegation urging them to oppose policies targeting PBMs.
The Milwaukee Courier, also last month, reported on a "multicultural coalition of small business owners" in Wisconsin who celebrated the defeat of PBM legislation, noting that if passed, the legislation would have "increased profits by billions of dollars for large pharmaceutical corporations."
And in April, a coalition of nearly two dozen business owners signed onto a letter sent to U.S. Sens. Rick Scott and Marco Rubio and to U.S. Reps. Aaron Bean, Donalds and Greg Steube labeling attempts to regulate PBMs as "misguided government mandates."
"Our ability to offer quality, competitive coverage and continue to rely on significant savings hung in the balance. Going forward, Congress must continue to recognize the disastrous consequences of government intervention targeting pharmacy benefits — which would increase costs for employers, taxpayers, and consumers while boosting profits for Big Pharma — and reject these pharma-backed proposals if they resurface in the future," the group wrote.
That future appears to be coming, according to Comer's press release announcing next week's hearing.
"PBMs have been allowed to hide in the shadows for far too long," he wrote. "I look forward to the Oversight Committee continuing to work in a bipartisan fashion to shine a light on how these PBMs have undermined community pharmacies, raised prescription drug prices, and jeopardized patient care."
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