OTHER VIEWS: Ensuring access to life-saving medicines in Oregon

Published 6:00 am Monday, May 15, 2023

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Millions of Americans have recently shared a common feeling when paying for their prescriptions: Sticker shock.

And Americans don’t just have an emotional response. According to a recent Kaiser Family Foundation study from last year, nearly one third of Americans have skipped a prescription treatment refill, cut pills in half, skipped doses or taken an over-the counter medication instead of paying unreasonably high costs.

Americans’ daily reality shouldn’t include struggling to pay for essential medications.

About 90% of all drugs sold in the U.S. are generics, and 85.6% of generics have declining price trajectories.

But hidden activities by pharmacy benefit managers (PBMs) have vertically integrated the prescription market with unfair, anti-competitive activities that drive up prices and limit patient choice — and Congress must take action to protect American patients.

If you’re not familiar with pharmacy benefit managers (PBMs), that’s because their actions are obscured by design.

PBMs utilize a variety of practices that drive price increases and hurt American patients. They choose which drugs are covered by insurers and which aren’t, frequently excluding generics and lower-cost options, which drives patients to purchase more expensive medications.

PBMs also keep rebates manufacturers intended to reduce patient costs — which generates huge profits with little benefit to patients.

And PBMs limit patient choice on where and how they purchase medications by determining which pharmacies are in-network and how much pharmacies are reimbursed. Frequently, they reimburse at such a low rate they don’t cover drug acquisition and pharmacy labor costs, forcing independent pharmacies across the country to close and reducing patient options.

In practice, these actions have a devastating impact on American patients and taxpayers.

Here in Oregon, a recent report found that our state’s Medicaid program had to pay eight times more than the manufacturer’s list price for a multiple sclerosis drug, costing the state nearly $2 million extra.

Congress has a solution to PBMs’ manipulations in front of them right now.

Just last week, two Senate committees marked up Sens. Maria Cantwell and Chuck Grassley’s Pharmacy Benefit Manager Transparency Act.

Sen. Ron Wyden has also long championed PBM reform and recently held a Finance Committee Hearing on PBMs’ unfair tactics, in which he called their practices a “raw deal” for American patients.

Though most are unaware of what PBMs are, every American that’s picked up a

prescription in recent years has felt PBMs’ impact on their wallet — and without affordable treatments, many quit taking necessary medications.

Out-of-pocket costs for drugs have risen 479% since 1980 according to the Center for Medicare & Medicaid Services, and it’s time for our leaders to take action.

The Pharmacy Benefit Manager Transparency Act is a strong, bipartisan step in the right direction to reduce our country’s outrageously high healthcare costs.

Only with federal regulation can our country ensure that Americans have affordable access to life-saving medications.

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