Time is of the essence for lawmakers who are hoping to bring about much-needed changes to the pharmacy benefit manager (PBM) industry. With each passing day, the window of opportunity to resurrect these changes is closing, and PBMs are breathing a sigh of relief as they continue to operate without much-needed regulations.
In December, a slate of changes to the PBM industry, including transparency requirements, a ban on “spread pricing”, and a provision to delink PBM payments from a drug’s list price, were stripped from the agenda. This was a major setback for those who have been advocating for reform in the PBM industry, and it has left many wondering if these changes will ever see the light of day.
PBMs, which act as middlemen between drug manufacturers and pharmacies, have been under scrutiny for their lack of transparency and their role in driving up drug prices. They negotiate drug prices with manufacturers and then determine which drugs are covered by insurance plans, often leaving patients with high out-of-pocket costs. This lack of transparency has led to a lack of trust in the PBM industry and has left patients and lawmakers alike frustrated and seeking change.
The proposed changes to the PBM industry were a step in the right direction towards bringing much-needed transparency and accountability to the industry. The transparency requirements would have forced PBMs to disclose the discounts they receive from drug manufacturers and how much of those discounts are passed on to patients. This would have given patients a better understanding of the true cost of their medications and allowed them to make more informed decisions about their healthcare.
The ban on “spread pricing” would have put an end to the practice of PBMs charging health plans more for a drug than what they reimburse pharmacies for it. This would have prevented PBMs from pocketing the difference and would have helped to lower drug costs for patients. Additionally, the provision to delink PBM payments from a drug’s list price would have incentivized PBMs to negotiate lower drug prices, rather than just focusing on increasing their own profits.
However, with these changes now off the table, PBMs are free to continue operating without any real oversight or accountability. This is a major blow to patients who are struggling to afford their medications and to lawmakers who are trying to bring about meaningful change in the healthcare industry.
But all hope is not lost. Lawmakers must act quickly to resurrect these changes and bring them back to the forefront of the agenda. The longer they wait, the more patients will continue to suffer from high drug prices and the more PBMs will continue to operate without any real regulations.
It is time for lawmakers to prioritize the needs of patients over the profits of PBMs. The PBM industry has had more than enough time to self-regulate and make necessary changes, but they have failed to do so. It is now up to lawmakers to step in and bring about the much-needed reforms that will benefit patients and the healthcare system as a whole.
In order to do this, lawmakers must work together to find common ground and pass legislation that will hold PBMs accountable and bring about transparency in the industry. This is not a partisan issue, but rather a matter of ensuring that patients have access to affordable medications and that the healthcare system is fair and just.
The clock is ticking, and time is slipping away from lawmakers. They must act now before it is too late and the opportunity for real change in the PBM industry is lost. Patients are counting on them to make the right decision and bring about the reforms that are long overdue.
In conclusion, the PBM industry has dodged a bullet with the removal of the proposed changes in December. But it is not too late for lawmakers to resurrect these changes and bring about much-needed reform. The time to act is now, and it is up to lawmakers to make the right decision and prioritize the needs of patients over the profits of PBMs. Let us hope that they do not let this opportunity slip away and that they bring about the changes that will benefit us all.
