Letter to the editor: Congress must rein in PBM middlemen


To the editor:

Like all things in the healthcare arena, prescription drugs are becoming more expensive and, for many, unaffordable.

Part of the problem is “pharmacy benefit managers” or PBMs. These are the companies that manage prescription drug benefits on behalf of health insurance carriers, Medicare Part D drug plans, large employers and other payers.

PBMs also control and in some cases own the large pharmacy outlets. They are often both the middleman and the retailer, and consumers are getting hammered in terms of their insurance costs, co-pays and access to affordable medications.

PBMs currently control the vast majority of the marketplace for prescription drugs. They control the supply. They set the prices. They decide what drugs are available. So how is this working, are prescription drugs more available and affordable?

The answer is no.

Are the PBMs getting rich based upon their quasi-monopoly of the market?

The answer is yes.

Is this good for the citizens of Iowa?

Again, the answer is no.

PBMs are middlemen. They negotiate with drug manufacturers and pharmacies to control costs and the supply. PBMs have a significant impact on patient’s access to medications, in determining what drugs are available, in determining the total drug costs for insurers and in determining how much pharmacies are paid.

In the end, is this better for the consumer and small businessman, the small-town pharmacy?

Once again, the answer is no.

Lawmakers have failed to rein in the harmful practices PBMs use to control the prescription drug marketplace.

At some point in our lives, we will rely on various medications to live comfortably. This is especially true for people who have diseases, such as diabetes, or who have chronic pain. The practices enforced by PBMs can make it much harder to access affordable medication.

As anyone who has dealt with a PBM knows, these groups use a range of overly restrictive policies—including step therapy, prior authorization and pharmacy steering—to help cut costs and boost profits. In the process, these same policies create access barriers and inflate out-of-pocket costs for patients at the pharmacy.

Patients should not have to fight to access their physician-prescribed medications and should not worry about higher out-of-pocket expenses due to the unfair policies enforced by PBMs. The “Delinking Revenue from Unfair Gouging,” aka the DRUG Act, would help protect the patient by increasing transparency into these practices and holding PBMs more accountable for their actions.

PBMs also have a terrible impact on the independent pharmacies that serve our small towns in Iowa. By cornering the market and using predatory tactics, PBMs are putting small, family-owned businesses out of business.

We need Iowa’s congressional delegation, including both Sen. Chuck Grassley and Sen. Joni Ernst as well as Rep. Mariannette Miller-Meeks to lead, to protect the people of Iowa and support the DRUG Act. This is important legislation that needs to be passed during this Congress.

Iowans cannot afford another year of inaction by our elected officials in Washington.

Scott W. Bates
West Des Moines


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