Op-Ed: Sen. Budd Can Protect Patient Savings by Opposing the PBM Reform Act
When Congress heads back to session post-August recess, they have a busy legislative agenda which includes funding the government to avoid a shutdown, passing the National Defense Authorization Act, the Farm Bill, and a whole host of other legislative priorities. During this busy legislative season, it is important to remain vigilant against nefarious efforts to pass bad legislation.
One such attempt taking shape is by Sen. Bernie Sanders, who is trying to attach his PBM Reform Act to the very popular insulin cap legislation. Unless our federal officials, like Sen. Ted Budd, stand against this effort, we could see this bill become law and lead to higher drug prices for patients.
This bill, as written, would create strict rules and limits on the agreements that pharmacy benefit managers (PBMs) and the groups they work with, such as businesses, unions, governments, and health insurance providers, voluntarily agree upon. Sen. Sanders has long-sought more government involvement in healthcare, and disrupting this successful component of the healthcare sector with additional bureaucracy risks taking us a step further towards his ultimate goal of socialized medicine.
And the end result would be worse health care outcomes for patients.
PBMs negotiate drug prices with manufacturers, and this negotiation leads to substantial cost reductions for patients. PBMs leverage their bargaining power, administering plans for more than 275 million Americans, to secure discounts and rebates from manufacturers, which in turn lowers the out-of-pocket costs for patients. These negotiated discounts are passed on to consumers, making medications more affordable.
A prime example of the costs associated with not using a PBM was highlighted in a report earlier this year from the Office of Audit within the Department of Labor (DOL) Office of Inspector General (OIG), which revealed that over a period of six years, the DOL exceeded its budget by $321.3 million for prescription medications within the Federal Employees’ Compensation Act (FECA) program due to not utilizing a PBM.
If Sen. Sanders has his way, increased prescription drug costs will become the norm.
But PBMs lead to better health care outcomes not just due to the cost-savings they are able to achieve. PBMs play a crucial role in ensuring that a wide range of medications are covered by health plans, and assess the safety, efficacy, and cost-effectiveness of medications, making informed decisions about which drugs to include in the formulary. This oversight helps ensure that patients have access to a variety of options, including generics and lower-cost alternatives, promoting competition and keeping prices and quality in check.
It's also important to recognize that PBMs help streamline the prescription process, making it easier for patients to access their medications. By working closely with healthcare providers, PBMs offer electronic prescribing and mail-order pharmacy services, reducing administrative burdens for both patients and doctors. This efficient process enhances medication adherence and patient outcomes.
PBMs negotiate drug prices, promote competition, and offer programs to assist patients in affording their medications. Rather than vilifying PBMs, and adding unnecessary governmental interference by passing the PBM Reform Act, legislators should prioritize ensuring patients' have access to affordable medications and reject this bad bill.
Retired Member of the Fayetteville City Council
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