NBC12, HEATHER SULLIVAN
Chances are you feel the pain when you fill a drug prescription. Prices are skyrocketing for many needed drugs.
But there’s a mystery at play: What’s really driving up prices?
Congresswoman Abigail Spanberger (D-District 7) wonders, too. She wants to pull back the curtain to help get prices down.
In the Davis family of Chesterfield, both Brian Davis and his son Joshua have type 1 diabetes. They say the escalating cost of insulin is breaking the bank.
“It’s stressful, it’s a lot of planning, it’s a lot of concern, especially in the first few months of the year,” said wife and mother Shannon Davis.
Even with insurance, they say they have to pay thousands for the drug each year.
“In January, we have to walk into the pharmacy to purchase five vials of insulin for Brian and two vials of insulin for Joshua. We don’t have the cash to just go and drop $1500 to $2000 for our insulin costs. So what we do throughout the year is we don’t waste any,” Shannon Davis explained.
Many pharmacists say they believe part of what’s driving up prescription prices are pharmacy benefit managers, or PBM’s, which are third party middlemen. PBM manages prescription drug benefits for health insurance companies by negotiating with drug manufacturers and pharmacies.
“Many patients are not aware of pharmacy benefit managers’ impact that they have on everyday prescriptions. Pharmacy benefit managers are determining what’s on formulary, determining what insurance will cover,” said Christina Barrille with the Virginia Pharmacists Association.
“Drugs that used to be covered and all of a sudden are not covered. And it’s going from a $10 co-pay to a $20 co-pay, to several hundred dollars,” said Joseph Jadallah, Pharmacist in Charge at the Buford Road Pharmacy.
They say sometimes these negotiated prices mean you’ll pay more using your insurance than paying cash. For example, the pharmacist tells us one patient who needed the drug Sertraline had an out-of-pocket cost using insurance of $32. But if they had paid cash for the drug, it was only $16.
“I had a woman come up and the woman grasped my hand and said I worry about this every day. My husband can’t afford his medication,” recalled Spanberger, saying prescription prices are among the most common complaints she hears in her district.
Spanberger wants to shed light on how prices are set. Her bill, the Public Disclosure of Drug Discounts Act, would require the rebates, discounts, and price concessions PBM’s negotiate to be made public on a website through the U.S. Secretary of Health and Human Services. The bill recently passed the House unanimously and is now in the Senate.
“If in fact PBM’s are contributing to the rising cost of prescription drugs, as many experts say they are, we need to know that,” Spanberger said.
She says her hope is that public awareness of pricing strategies could create an incentive to help keep prices down.
“That’s certainly one of the hopes and one of the expectations,” she said.
AARP Virginia State Director Jim Dau says the organization supports the bill, but also believes drug makers should be transparent, too.
“We know the biggest driver of prescription drug costs is the price set by the manufacturer at the start,” said Dau.
The Pharmaceutical Care Management Association, which represents PBM’s, sent us the following statement on the bill:
“PBMs support increasing transparency across the entire prescription drug supply chain. We will continue to review the legislation, and we look forward to working with Congress to reduce prescription drug costs for consumers.
“PBMs practice and support transparency for consumers, physicians, clients, and policymakers. PCMA’s principles on transparency include: providing real-time benefit tools, so physicians and patients know at the point of prescribing what drugs are on formulary and patients’ cost-sharing, providing information to clients on all contract terms, including how PBMs are paid for their services and negotiated rebates, (and) providing government regulators, such as CMS for Medicare Part D, information on price concessions, costs, and service fees.”
PCMA showed us to an educational video that says PBM’s save consumers an average of $941 a year by negotiating rebates and discounts from drug manufacturers and pharmacies.
The Davis family hopes Spanberger’s bill will help cut their prescription bill.
“We have good insurance, yet we feel the pinch on a monthly basis. When I think about others who don’t have as good insurance, or no insurance at all, it’s just really frustrating,” said Brian Davis.
Spanberger also recently co-sponsored the Lower Drug Costs Now Act to give Medicare Part D the power to negotiate directly with drug companies to help lower prescription prices. It has also passed in the House and is currently in