ARRMAN KYAW, HENRICO CITIZEN

U.S. Representative Abigail Spanberger heard the stories, challenges and concerns people face related to high prescription drug prices and an overall lack of transparency, during a roundtable Monday at the VCU Health Neuroscience, Orthopaedic and Wellness Center in Short Pump.

Those who spoke came from various facets in the pharmaceutical process, including patients, families, providers and pharmacists.

During the event, Spanberger – a first-term member of the U.S. House of Representatives from Virginia’s 7th congressional district – cited a number of major problems with prescription drugs. One, she said, is a lack of earnest competitiveness in prescription drug pricing; another is a lack of transparency throughout the pharmaceutical industry for patients and prescribers.

“And so, there’s zero transparency in where that price exists,” Spanberger said. “Prescribers don’t know how much those medications cost. You can’t necessarily get a good answer until you are actually going to pick up your medication from the pharmacy.”

There’s also a problem with how medical needs are being addressed, she said.

“From my perspective, in this country, we are spending far more to be reactive to medical needs,” Spanberger said. “We are spending far more to be reactive to people in extreme circumstances, because if it’s a diabetic. . . some patients who will push themselves to the precipice of diabetic shock because they can walk into the emergency room and get immediate care, but in fact they can’t get their insulin covered or they can’t pay for their insulin to avoid them ever getting to that place.”

Two diabetics from one family described how high costs of insulin – most of which they need to pay out-of-pocket until they meet their deductible – restricted their insulin purchases for the year.

A prominent issue discussed at the event was that of pharmacy benefit managers, or PBMs, which serve as intermediaries that administer prescription drug programs. Roundtable attendees, both patients and pharmacists, saw PBMs as costly and often not transparent third parties.

One pharmacist spoke about how PBMs were benefitting from the pharmaceutical industry while patients and pharmacists struggled.

“They’re getting rebates from the manufacturer,” the pharmacist said. “They collect the co-pays. And then they want to pay us, as pharmacists, below the cost for us to buy the drug. We’ll send a claim in and we’ll be losing $20 to $30 trying to fill your prescription.”

The family of two diabetics said that learning about the very existence of PBMs had been eye-opening.

Express Scripts – the largest PBM in the U.S. and since December 2018, a subsidiary of health insurer Cigna – was ranked 25thof 2018’s Fortune 500, earning a revenue of more than $100 billion and profits of more than $4 billion.

One mother also shared the story of her daughter, who suffers from PANDAS (a chronic autoimmune neuropsychiatric disorder caused by strep bacteria), and how a treatment that costs more than $15,000 that could help her recover is being denied by the health insurance company. Her daughter has been on antibiotics for almost three years, the mother said.

“And you would look at my child and you might think she’s just quiet,” the mother said. “You might think that she’s just a little slower to answer. Anxiety, depression, OCD, these are things that people can’t see. You can’t see that there’s something wrong with my child. But she’s been struggling with this for so long, I don’t even know what her life would be like if we weren’t dealing with this problem.”

Spanberger – who has been in office for seven months – has worked on several efforts regarding the high prescription drug costs and the pharmaceutical industry. This year, she introduced a bipartisan bill – the Public Disclosure of Drug Discounts Act, which aims to increase transparency by requiring PBMs to publicly report their aggregate rebates and other price concessions for prescription drugs. The bill has passed unanimously out of the House Ways and Means Committee and passed out of the House Energy and Commerce Committee.

She also cosponsored and helped pass the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2019 in the U.S. House of Representatives that allowed generic drug manufactures to get better access to samples they need.

Speaking exclusively to the Citizen after the roundtable, Spanberger said that the issues as they are now were hurting everyone.

“The biggest takeaway is that the system’s really broken and it’s hurting everybody involved,” Spanberger said. “It’s hurting the small pharmacies. It’s hurting the patients tremendously. It’s causing agony for families and parents who are trying to keep their kids healthy.

“So, in being reactive instead of really prioritizing our prevention and our proactive engagement, it’s costing us more money. People are sicker.”