SAVANNAH, GA – Rep. Earl L. “Buddy” Carter (R-GA) today announced the “Pulling Back the Curtains on PBMs” report, an initiative to educate members of Congress and the public about the role of benefit managers pharmaceutical companies (PBM), the pharmaceutical middlemen sector of the industry, contribute to increasing drug costs, delaying necessary treatment for patients and robbing loved ones of hope.
This initiative focuses on the people at the heart of the problem, who struggle with PBM to access basic treatments and prescriptions. By highlighting their stories and presenting them to members of Congress who can curb PBMs, Rep. Carter, patient advocates and healthcare providers hope to put a face to the often obscure role PBMs play. in creating barriers to medically necessary care. treatments and care.
Watch and read their stories here.
“We call to action” said Rep. Carter. “PBMs have been allowed to steal from blind patients for decades and Congress cannot afford to continue to ignore a system that forces our loved ones to stay sick, sacrifice their sanity, go into debt and put their lives on the line. life on hold just to convince a man behind a computer that they need the care their doctor says they need. I’m a pharmacist, I’ve seen this first hand. Congress can attack the drugmakers all it wants, but here’s the truth: Until PBMs are brought under control, nothing will change.”
“Every day across America, millions of real patients with chronic diseases are forced to confront the politics of PBMs, the self-interested gatekeepers of patient care, determining which pharmacies, medications, and therapies patients can access. “, despite what their doctors prescribe. PBMs have continued to line their pockets with patient discounts at the pharmacy counter, creating a healthcare ecosystem that puts PBMs at the center, not patients.”, said Terry Wilcox, CEO and Founder of Patients Rising Now.
“PBMs delayed my therapy and changed the order of my treatments, not because it was better for my health, but because it was better for their results. The stress of battling the health industry for basic care is costing me time, money, and mental energy, all of which have a negative impact on my health.The worst part of Crohn’s disease shouldn’t be battling PBM, but sometimes it does.” said Jessica Wofford, a patient interviewed for this project.
“It’s a scary time to be a patient in America. PBM boardrooms have taken control of the doctor-patient relationship and sacrificed patient well-being on the altar of financial gain – I call it Instead of decisions about my care being dictated by what treatment is medically best for me, my care plans are determined by the math spreadsheet that fills the PBM’s pocket the most. As a patient, being trapped in this funny money war is often worse than the physical diagnosis itself” said Elisa Comera patient interviewed for this project.
Several groups expressed support for Rep. Carter’s initiative:
“Currently, 8 out of 10 Americans say prescription drug prices are too high. Pharmacy benefit managers have dominated the prescription drug market for years, creating a system that prioritizes profits over life-saving drugs. Our organizations represent hundreds of thousands of employers, healthcare providers and patients whose access to medicines is threatened every day by a handful of companies that have been able to operate for far too long with little or no oversight. . We applaud Congressman Buddy Carter for shedding light on the harmful effects of PBMs. – Coalition for PBM Reform
“The best PBMs have a stranglehold on the prescription drug market, interposing themselves between patients and their physicians, causing unnecessary suffering by delaying, denying and obstructing care. As a result, cancer patients and ‘other serious illnesses often don’t get the treatment they need and end up paying more for their medications’, said Ted Okon, executive director of the Community Oncology Alliance. “Members of Congress and government regulators need to ask themselves, ‘If you or a loved one were faced with cancer, would you want PBM to obstruct your care?’ The obvious ‘no’ answer is why PBMs need to be stopped.”
“I have been HIV positive for 17 years. My pharmacist is one of the main reasons I have stayed healthy during this time. My pharmacist knows me and knows what is best for me. If I couldn’t talk to him or ask him questions, I am losing a valuable connection to my health care. PBMs do not understand the importance of this relationship that people like me have with their pharmacist. Their selfish efforts that focus only on profit are are doing to the detriment of people living with HIV. We need our direct links to our neighborhood independent pharmacies – they are a lifeline for many of us,” said John Farina, Associate Director of Advocacy – Social Media Platforms for the AIDS Healthcare Foundation.
“PBMs continue to undermine affordable access to the medicines and treatments Georgians need to stay alive, achieve their peak well-being, and stay productive for their employers, families, and communities. It’s time for our lawmakers to act now and pass laws to provide strong oversight of PBMs, transparency in drug pricing, and protection of patients from egregious PBM practices, all of which dramatically increase overall health care costs. a healthier prescription market when we rein in the middle profiteers of PBMs and leave the practice of medicine to healthcare professionals,” said Dorothy Leone-Glasser, executive director of Advocates for Responsible Care (ARxC) and project chair of the Rx in Reach GA Coalition.
“PBMs are the healthcare industry intermediaries responsible for negotiating drug prices and establishing an insurer’s formulary or list of covered drugs. What Americans may not realize is is that PBMs receive significant rebates or rebates in return for placement on an insurer’s formulary, and there is no expectation that PBMs will disclose these rebates or pass the savings on to patients. PBM in healthcare is believed to unlock value and cost savings, however, in practice, PBM policies promote many of the problems plaguing the US healthcare system,” said Brian Nyquist, executive director of the Infusion Access Foundation.
“The Autoimmune Association is working with Congress to advocate for transparency in the practices of pharmacy benefit managers. We hope that PBMs will begin to understand the impact of some of their protocols on the patient community. We are proud to ‘co-leading a signature letter to the FTC highlighting how PBM practices harm patient care and fuel higher costs’, said Quardricos Driskell, vice president of public policy and government affairs for the Autoimmune Association.
“Form design decisions are not driven by what’s best for patients, but by what’s best for PBM’s bottom line. Once the form is set for a contract year, PBM s “rely on aggressive utilization management to drive patients to the most cost-effective product for itself. This approach interferes with clinical care and the doctor-patient relationship. Our drug pricing system will remain broken until that these perverse incentives are corrected,” said Dr. Robert Levin, President of the Alliance for Transparent and Affordable Prescribing.
“PBMs negotiate with pharmaceutical companies for rebates, rebates and other price concessions, and in exchange, pharmaceutical companies receive preferred placement on the formulary. Drugs that offer the greatest revenue potential for PBM get the top spots on the formulary. The PBM will then use aggressive utilization management tools to encourage patients to switch to these drugs. Since a drug’s list price must be high in order to provide a “margin” for these payments to PBM, high drug prices are not just a by-product of this system – they are at the heart of its design “, said Madelaine A. Feldman, MD FACR, vice president of advocacy and government affairs for the Coalition of State Rheumatology Organizations.
Read the full report and watch patient testimonials here.