Why America needs pharmacy benefits reform now

Independent Newsmedia

I run a small business and live with multiple sclerosis. Every few months, I have to fight to get the medication that keeps me going. My doctors know what I need, but the insurance process wears me down — pre-authorizations, denials, delays. It’s exhausting.

Politicians say they want to lower drug prices, and I’m all for it. However, I’m worried about using policies like the Most Favored Nation rule to do that. It sounds like an easy enough shortcut, but relying on other countries’ drug pricing systems to set our prices wouldn’t address the factors that lead to higher prices for Americans. It might not even deliver direct savings to patients.

The real problem is right in front of us: PBMs, or pharmacy benefit managers. These are the prescription drug middlemen who control patient access, delay approvals and boost their profits by withholding savings and rebates that should be getting passed down to patients like me. They make the system harder to manage and less efficient. The only thing they’re good for is protecting their bottom line.

Congress should be focused on PBM reform. That’s something we can do now to lower costs, cut through the red tape and make the system fairer for patients.

Our leaders in Washington, including Sens. Mark Kelly and Ruben Gallego, and Rep. Juan Ciscomani, should support the PBM Reform Act. We need change that puts people before profits for once.

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