The Role of Pharmacy Benefit Managers In Prescription Drug Markets
Earlier in March, Boesen and Snow had the privilege of meeting with members of the House Committee on Oversight and Accountability including Chairman of the House Oversight Committee James Comer (R-KY.), Raja Krishnamoorthi (D-IL.), and Andy Biggs (R-AZ) to discuss the role PBMs play in America’s Healthcare System and to offer talking points on the anticompetitive practices utilized by the PBMs to line their own pockets. Boesen and Snow also met with Representatives Cory Mills (R-FL), Ben Cline (R-VA), Diana Harshbarger (R-TN), Burgess Owens (R-UT), Jeff Van Drew (R-NJ), and Andrew Clyde (R-GA) to educate and discuss the need for PBM reform.
On May 23, 2023, The House Committee on Oversight and Accountability held a hearing to discuss the role of Pharmacy Benefit Managers in Pharmaceutical Markets. Evidence of Boesen and Snow’s lobbying efforts to promote PBM Reform are apparent in Chairman Comer’s opening remarks:
“Today is the first public hearing this Committee had held to examine the behind-the-scenes tactics that PBMs use to prevent payers—including government payers like Medicare, Medicaid, TRICARE, and the Federal Employee Health Benefits program—from understanding how PBMs are making billions at the expense of patients and taxpayers.”
“Now, instead of fierce competition, three large PBMs—CVS Caremark, Express Scripts, and Optum Rx—collectively control approximately 80 percent of the market.”
“Today, every major PBM is owned by a major health insurer and owns or is owned by a specialty, mail-order, or retail pharmacy, or all three. This means that when PBMs negotiate with a pharmacy or a health insurer, they are either negotiating with themselves or one of their direct competitors.”
“Today, PBMs engage in self-benefitting practices that boost their bottom line without a benefit to patients.”
“In the Medicare program, PBMs often claw back billions of dollars in reimbursements paid to competing pharmacies.”
“PBMs also steer patients to certain pharmacies and to certain medications.”
“From what we have seen many PBMs are acting without consequence to the detriment of patients and their pocketbooks, because PBMs have been allowed to hide in the shadows. It’s time to bring them into the light.”
The house oversight committee is clearly intent on examining further, the anticompetitive practices and monopolistic operations of the three big PBM’s. It is clear that the Chairman‘s intent is to continue to highlight the destructive practices of these corporations, and define how they operate in the future. Boesen & Snow will continue to work with Chairman Comer, and several members of the oversight committee to forge a level playing field where independent pharmacy, patient care, and the pocketbooks of all patients are treated fairly. There will be multiple hearings this year on PBM’s in the oversight committee. Along with House Energy & Commerce congressional Republicans will forge a bill that leads to lower cost for healthcare, improved access to medications, and allow independent and community pharmacies to serve their patients in their communities whenever they, their physician, and pharmacist desire without the roadblocks created by PBM’s seeking only greater profits over patient care.
The time is now to advocate for change and speak with your state representatives to drive Congress down the path of PBM Reform. Boesen and Snow’s lobbying experience can assist clients as a voice for change with representatives at the state and federal level.