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Nearly 2,000 Organizations Urge Congress to Pass PBM Reform

A coalition of nearly 2,000 employers, patient advocates, pharmacies, providers and businesses sent a letter to Congress on Wednesday urging the passage of legislation that would reform PBM practices.

The pressure continues to build against pharmacy benefit managers and their practices that critics say raise drug prices. This time, it’s a coalition of nearly 2,000 employers, patient advocates, pharmacies, providers and businesses.

These groups, led by FMI – The Food Industry Association and the National Community Pharmacists Association, sent a letter Wednesday to the United States Senate and House of Representatives urging for the passage of legislation that would reform PBM practices. The coalition includes national names like The Kroger Company, the AIDs Healthcare Foundation, Brookshire Brothers and the American Pharmacists Association.

“We urge you to seize this opportunity and pass legislation that will significantly reform the PBM industry to achieve a health care system that prioritizes patient well-being, promotes competition, ensures fair pricing and access to essential medications, and ultimately reduces costs to plan sponsors,” the coalition stated in the letter.

Congress has recently introduced several pieces of legislation that target PBMs. This includes the Transparency in Coverage Act, introduced in the House on Monday; the Pharmacy Benefit Manager Reform Act, introduced in the Senate in April; the Pharmacy Benefit Manager Transparency Act, introduced in the Senate in January; the Drug Price Transparency in Medicaid Act, introduced in the Senate in March; and the Patients Before Middlemen Act, introduced in the Senate in June. The coalition said in the letter that they’re “encouraged by the momentum,” but that “there is still much work to be done.”

While the coalition requests the passage of legislation against PBMs, it also asks that federal legislative efforts don’t prevent state efforts to “regulate the relationships between PBMs and pharmacies, a relationship that the Supreme Court unanimously ruled is not subject to [Employee Retirement Income Security Act].”

“Individual states have recognized that the largest PBMs that are vertically integrated with health insurance companies, acquired pharmacies (retail, specialty and mail-order) and rebate aggregators, driving up costs for prescription medications, delaying access to necessary treatments, shuttering pharmacies and giving higher–priced drugs more favorable health-plan coverage,” the letter said. “Many states have taken action to address the lack of transparency that has created an environment in which PBMs are free to engage in anticompetitive and deceptive behavior that harms patients, some of whom are our employees, while also passing on hidden costs to us that inhibit our ability to innovate and grow. It is important to note that in these states that have implemented PBM reform, there is no evidence that health insurance costs have increased.”

If Congress moves on these measures, drug costs will ultimately go down, the coalition declared.

“By passing PBM reform measures that also preserve the rights of states to impose stricter regulations, Congress has the power to lower prescription drug costs and alleviate the financial burden on patients and the health care system at large, while enhancing access to affordable medications for our employees and promoting a healthier, more competitive business environment,” the coalition said.

The letter comes after the National Alliance of Healthcare Purchaser Coalitions released a playbook for employers that explains the drivers behind prescription drug costs and what the best practices are. The FTC also has an ongoing investigation into PBMs.


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