By Sherry Weinstein / For The Herald
The rising cost of prescription drugs has become a major burden for individuals and families across our country.
ICAN, International Cancer Advocacy Network, works every day with late-stage cancer patients to improve access to the anticancer drugs that they need in this era of personalized medicine. We know all too well that anticancer medications often have high costs. These costs tend to be highest in the last year of life, creating a serious barrier to access and affordability, and impacting quality of life.
One often-overlooked solution to lower costs for medications is to limit the influence of pharmacy benefit managers (PBMs) in our health care system.
PBMs are middleman companies (often owned by insurance companies) with sole authority to negotiate drug prices and manage pharmacy access to therapeutics. Just three PBM companies control more than 80 percent of the market. This power can dramatically increase the cost of medications for patients at the pharmacy counter. Often, we see PBMs prioritize profits over patient care by engaging in opaque practices that can drive up out-of-pocket expenses, restrict patient access to affordable medications, and undermine the ability of independent pharmacies to provide service to communities.
To address this issue, both state and federal policy action is key. Last year, for example, an excellent bipartisan bill in the state Senate, Senate Bill 5213, was passed by the Legislature. It is a groundbreaking law that aims to increase transparency, ensure fair reimbursement, and protect patients from predatory PBM practices. The need for SB 5213 was shown in a report by the Washington State Pharmacy Association (WSPA) and Washington Health Alliance (WHA) that sheds light on these troubling practices. By manipulating drug prices, restricting pharmacy networks, and refusing to pay local pharmacies for their services, PBMs have been significantly increasing the cost of medications for Washington patients; and this is happening all across the country.
At the federal level, bipartisan action is also needed. For example, House Resolution 5378, the Lower Costs, More Transparency Act, was introduced last year and offers a comprehensive solution to the PBM problem. This bipartisan legislation would impose much-needed transparency and accountability on PBMs, requiring them to disclose their pricing practices and pass savings onto patients. It would also protect independent pharmacies from unfair reimbursement practices, ensuring that patients have access to a diverse range of health care providers.
HR 5378 was passed last year in the House by an overwhelming bipartisan vote of 320 to 71. It was almost included in what was to be a large, comprehensive package of many Senate bills in December, but was dropped when Congress could only agree on a temporary budget solution to keep the government open. Now that there is more time, Congress needs to revisit PBM reform and pass it individually or include it in a larger package.
State and federal policymakers must work together to create a structural shift of power in favor of patients, families, and health care professionals across the country. Unaccountable PBMs shouldn’t have the authority to override the decisions made between patients and their physicians about what medicines they can access.
It’s time to level the playing field, empower patients, and protect access both to medicines and to our local pharmacies. Let’s work together to bring accountability and transparency to drug pricing and ensure that all of us have access to the affordable medications we need to survive and thrive.
Sherry Weinstein is the chairman of the board of ICAN, International Cancer Advocacy Network, a nonprofit organization specializing in research advocacy.
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