SAVANA, GA – Representing Buddy Carter, BSPharm (R-Ga.), pharmacist and former pharmacy owner, escalated his long-running battle with the Pharmacy Benefit Manager (PBM) Friday, A report was released criticizing the industry and calling for changes to the PBM rebate system.
“What we’re trying to achieve in healthcare is accessibility, affordability and quality,” Carter said at a news conference meeting in the pharmacy’s parking lot here. “PBM is compromising access, affordability, and quality of healthcare.”
Carter published a paper titled “Pulling the Curtain on PBM: A Path to Affordable Prescription Drugs” way” report. The report includes stories of patients who have had difficulty accessing medication due to PBM rules or exorbitant drug costs.
The report also urges support for a regulation issued by the Trump administration — but delayed by the Biden administration — that would force pharma rebates to be passed on to patients at the point of sale, rather than being absorbed by PBM. It urged Congress to support existing legislation, such as the Pharmacy DIR Reform Act to reduce the cost of advanced drugs and the Drug Price Transparency Act in the Medicaid Act, that would curb some PBM authorities and force them to be more transparent about their pricing strategies.
During the news conference, the speakers — several of whom also appeared on Carter’s report — outlined the problems they experienced with medication. Jessica Wofford, a nurse with Crohn’s disease for 15 years, said her monthly injections of 1 milliliter of ustekinumab (Stelara) cost $24,900. “My insurance company is great, they’ll pay $17,000 of it, and leave the other $7,000 for me to figure out how I’m going to pay.”
Wofford said she attended Two copay assistance programs were introduced to help make up the difference. “I took the second one because I ran out of the first in March of this year…and the problem with these drugs is that they are authorized by your insurance, [but] your insurance will only go through a specific specialty pharmacy Licensing. You can’t buy these drugs; unfortunately, you can’t go online and find a better price.”
Terry Wilcox, CEO and founder of Patient Rising NOW, a group of advocates A patient with better access said she recently went to a pharmacy to buy ear drops for her son. “They said, ‘That’s going to be $210.'” When Wilcox said the price was usually not that high and the GoodRx app quoted $80, the pharmacy told her she couldn’t pay that price because it wouldn’t count her deductible.
“I was like, ‘Why would I pay twice and a half more for something so it can count towards my deductible? I want this,'” she says. “So I ended up paying the price. But that’s the shenanigans you go through.” Elisa Comer, a health care administrator, said: “There should never be a pharmacist or a doctor who has told a The mother, she couldn’t [get] medication for her child with juvenile arthritis,” to put the child back in a wheelchair for the next year and a half. “These are true stories,” Comer said. She said she herself had struggled so hard with PBM for a year that “I had to give up and stop taking my meds.”
“I have a message for you PBM: us” Find you again, we’ll find you,” she said. “These are the hills on which we’d love to die. We are tired of you hijacking our healthcare. And a word from my chronically ill family – you stay the course and you stay there to fight. ‘Let’s go away. ‘ ‘ Her last words were those of Todd Beamer, a passenger on the hijacked flight on September 11, 2001, who said “let’s get out” before he and some other passengers stormed in. They tried to derail the hijackers.
When asked about their response, the PBM’s trade group, the Pharmaceutical Care Management Association, issued a statement saying, “Americans have consistently rejected the use of accusations.” Game strategy, especially when the health and life of real patients are at stake. This is especially true when blaming PBM, an entity that reduces costs to the health care system. “
“An overlooked reality is that for most Americans, the average patient out-of-pocket cost is actually falling due to the proven negotiating power of PBM [sic] Pharmacies and drug manufacturers provide nts on behalf of patients,” the statement said. “Without the affordability and coordination of care provided by PBM, patient access to medicines would be limited. We urge other members of the prescription drug supply and payment chain to lay down their swords and join us in making prescription drugs affordable to more Americans. ”
Joyce Frieden oversees MedPage Today’s Washington coverage, including coverage on Congress, the White House, the Supreme Court, healthcare industry associations, and federal agencies. She has 35 years of experience in healthcare policy. Follow