PEZZILLO: The real cause of high prescription drug prices? PBM

Our nonprofit organization represents people with bleeding disorders and their families throughout New Hampshire. We are committed to improving the quality of their lives, and the high cost of prescription drugs, especially the specialty drugs that our patients rely on, has a huge impact on these families.

It doesn’t have to be that way. We can and must reduce the cost of prescription drugs. This can be done relatively easily by cutting out the middlemen who significantly increase the cost of drugs beyond the manufacturer’s price.

It is critical that patients and policy makers understand and consider the role that intermediaries play in the drug pipeline, especially pharmaceutical benefit managers (PBMs). PBMs should play an important role in our healthcare system and strive to reduce the price of prescription drugs. However, they put profits ahead of patients and contribute significantly to drug growth by not passing on negotiated discounts on drugs from drugmakers to patients.

The Berkeley Research Group (BRG) released a study in January that documented that PBMs and other intermediaries now consume more than $0.50 of every dollar spent on brand name drugs. President Joe Biden focused on the price of insulin in his State of the Union address, but he failed to mention that more than half of insulin spending goes to PBM intermediates, according to a recent USC Schaeffer study.

Importantly, we saw some initial policy changes implemented by regulators as they learned more about how the drug supply chain works. Yet, if the goal is to protect patients from overpayment for prescription drugs, these reforms remain insufficient. Our elected officials need to take a hard look at the role PBMs play in driving up the cost of prescription drugs, especially ensuring that they are reimbursing the patient for prescription drugs instead of lining their own pockets.

As the direct costs of treatments like hemophilia and many other groups continue to rise, the patient advocacy community continues to worry about drug hoarding, where patients extend their prescription drug regimen instead to take it as prescribed. Rising gas prices and rising inflation will only exacerbate this unhealthy and dangerous practice. I urge regulators and our political leaders to consider the roles that PBMs and insurers play in driving up drug costs and include them in any meaningful drug price reform debate or legislation. American patients need relief, and these intermediaries are doing nothing to help the cause.

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