Pharmacy middleman fuels lobbying electric shock

Although there is little agreement between PBM opponents on what Congress should do, industry lobbyists offer a menu of options for Democrats to consider. They can also claim more health insurance than PBM pays to the pharmacy that dispenses the drug and ban a common practice called spread pricing that puts the difference in your pocket.

PBM claims to be scapegoated, responding with its own lobbying and advertising blitz. JC Scott, head of the Pharmaceutical Care Management Association, a PBM industry group, said targeting members is a good politics and may remove focus from pharmaceutical companies at key moments in the debate, but it lowers drug costs. It doesn’t mean that.

There are dozens of PBMs, but the industry is integrated, three of which (CVS Caremark, Express Scripts, OptumRx) control nearly 80% of the prescription market. Health insurance companies, employers, and governments hire PBMs to manage prescription benefits for their health plans. This puts PBM at the heart of the supply chain, which consists of pharmaceutical companies, insurance companies and pharmacies.

Critics say that PBM’s role in negotiating rebates from pharmaceutical companies and creating a list of prescription drugs covered by health insurance companies is not to focus on low-cost drugs, but to obtain higher rebates. It claims to encourage the priority of cost medicines.

Senator Patty Murray, Washington, said in a statement, “The Democratic Party is focusing on reducing patient costs, which ensures that drug benefit managers make the best deal for patients, not themselves. It also includes making it available. “

The $ 1.7 trillion spending bill passed by the House of Representatives last month to PBM While it aims to disclose specific information to employer-based plans and help them negotiate better prices for drugs, other industry lobbyists want Democrats to be far more advanced. I’m out.

Independent pharmacists and their patients sent thousands of letters to Congress at the request of the National Association of Community Pharmacists. This unleashes its own TV advertising campaign that encourages Senators to curb PBM in the coming days.

On Friday, the pharmaceutical industry launched a seven-digit national advertising campaign that urged legislators to force PBMs to pass rebates directly to consumers at pharmacy counters. PBMs and others, called POS rebates, claim that this ultimately raises premiums.

“On both sides of the aisle, there is recognition that PBMs play an important role in broken insurance systems, but for some reason, bills aimed at lowering drug costs allow patients to pay from their pockets for drugs. It does not address the role these intermediaries play in making decisions. ” Sarah Sutton, a spokesperson for the Pharmaceutical Research and Manufacturers of America (PhRMA), which advertises on television, radio and the Internet, said.

According to Ad Analytics data analyzed by POLITICO, she didn’t reveal a new advertising price tag, but PhRMA spent more than $ 2.5 million on TV ad purchases during the summer and negotiated drug prices with Medicare. I opposed the free effort to make it. The group also spent more than $ 22 million in lobbying during the first nine months of 2021, up 10% from the same period in 2020.

While pharmaceutical companies were the main goal of the Democratic Party’s efforts to reduce drug costs, PBM, which spent $ 5.9 million on lobbying in the first nine months of this year, compared to the same period in 2020. It increased by 20% and appeared almost intact. House version.

The PBM industry is still concerned about transparency provisions, but has succeeded in blocking the Democratic Party from including a ban on spread prices. The industry also supported the abolition of the Trump administration’s so-called rebate rules, which became the house version of the bill.

This has forced pharmaceutical companies, pharmacies, and employer group lobbyists to file proceedings in the Senate. Senator Ron Weiden (D-Ore.), Chairman of the Senate Finance Committee, is already interested in a closer look at the role that PBM plays. With adjustment package.

“Chairman Weiden is the champion on this issue,” said James Gelfand, vice president of public relations for the ERISA Industry Commission, which represents the benefits of the largest employer in the United States. “So it would be strange to think that he isn’t thinking about’what else can be done in this space’now.”

“It’s a legislative opportunity for this century,” he added. “Don’t give up, right?”

“While family members and local pharmacies are submitting bills, pharmacy benefit managers are using this dysfunctional system,” Weiden said in a statement to POLITICO. We need to change as much as possible. Big Pharma. “

Scott, the leader of PCMA, says his industry is unfairly malicious for two reasons.

“There is this sentiment around some stakeholders, believing,’Well, if part of the pharmaceutical supply chain is affected by this law, the PBM industry also needs to give that body.'” “He said. “And I don’t know that it is a very thoughtful consideration to put into policy making.”

The group launched its own advertising campaign last week, accusing rivals of trying to shift responsibility for rising drug prices.

“Ironically, the industry that manages prescription drug pricing has sought to focus on reducing the cost of prescription drugs for patients and payers,” said Beltway. Read the text of the digital campaign.

However, the employer group Gelfand said maintaining the status quo is unacceptable to patients.

“Everyone involved in all of this knows that the current system is completely unsustainable,” Gelfand said. “Some are trying to change that, while others are essentially trying to get rid of what they can do from it as much as possible.”

Pharmacy middleman fuels lobbying electric shock

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