North Cook News

WASHINGTON — Congressman Raja Krishnamoorthi helped introduced bipartisan legislation today to help tackle the prescription drug affordability crisis, hold pharmacy benefit managers (PBMs) accountable, and lower drug costs. In the face of high prescription drug costs, many independent experts are concerned that the practice of using PBMs as the middlemen between drug manufacturers, health insurers, and pharmacies is contributing to rising prescription drug prices and increasing out-of-pocket costs for American patients. In 2019, PBMs took in an estimated $28.05 billion in gross profits as consumer drug costs skyrocketed. And right now, the three largest PBMs — CVS Caremark, Express Scripts and OptumRx — control nearly 80 percent of the prescription drug market. However, pharmacists are unable to see the rebates and discounts received by these powerful PBMs, meaning consumers are unable to learn more about how PBMs could be benefiting from rising drug prices and increasing their out-of-pocket costs.

The PBM Sunshine and Accountability Act, which is also cosponsored by Representatives Diana Harshbarger (R-TN), Abigail Spanberger (D-VA), and Mariannette Miller-Meeks (R-IA) would establish new public reporting requirements for Pharmacy Benefit Managers (PBMs). Specifically, the legislation would require PBMs to report to the U.S. Department of Health and Human Services (HHS) their aggregate rebates, administrative fees, and other revenue received from drug manufacturers and healthcare entities. To improve the ability of patients, health policy researchers, and other stakeholders to gauge the effectiveness of their PBMs, these reporting requirements would be made public at least once a year. Additionally, this increased transparency would allow Members of Congress to take further action to lower drug costs.

“Patients and providers need greater transparency in the prescription drug market to ensure they are receiving the discounts and rebates they deserve,” said Krishnamoorthi. “I am proud to join my colleagues in introducing our bipartisan legislation to bring more accountability to the practices of pharmacy benefit managers, which will ultimately help bring down the costs of prescription drugs for Illinoisans and all Americans.”

“For far too long, PBM middlemen have exploited a lack of transparency and created conflicts of interest in ways significantly distorting competition at consumer expense – and where there’s mystery, there’s margin,” said Harshbarger. “My PBM Sunshine and Accountability Act will finally require PBMs to report critical financial information on their operations, which will enable patients and providers to see which PBMs are adding value, and which ones are printing their own money. This legislation will shine a bright light on the ways that PBMs avoid regulation and siphon off countless dollars from our supply chains, and equip policymakers to prevent these practices to save healthcare dollars.”

“During this moment when PBMs hold tremendous power across the American pharmaceutical industry, we need to know if the behaviors of these middlemen are contributing to higher drug prices for American consumers,” said Spanberger. “By increasing reporting requirements, our PBM Sunshine and Accountability Act would help shed more light on the murky world of PBMs. Our bipartisan bill would give Congress more tools to dig into their practices — and it would give the American people more information about how PBMs might be manipulating the sticker prices of medications. In this way, we can pursue reforms that will lower drug costs for the Virginians I serve.”

“We can all agree the issue of rising drug costs must be addressed, and PBMs often fall in the center of this controversy,” said Miller-Meeks. “Our bill, the PBM Sunshine and Accountability Act, will require PBMs to report critical data that will help patients and providers to make informed decisions. I’m proud to join in leading this important, bipartisan bill to shed light on PBM practices.”

The PBM Sunshine and Accountability Act is endorsed by the National Community Pharmacists Association, Virginia Pharmacy Association, and additional healthcare advocacy organizations.

Click here to read the full bill text.

Original source can be found here.