Op-Ed: The Hill: Transparency is a first step in bringing down drug costs for American seniors, families


Wherever I go — be it to school events, county fairs, town halls, or even the grocery store, my neighbors and constituents share the same serious concern. Prescription drug prices keep going up, and families across our district don’t know how they can afford them. Hardworking Americans are making real decisions about how and whether to fill prescriptions and whether to prioritize their health or their finances. The consequences are dire, and Congress must take action.

During an August roundtable on the issue of prescription drug costs in our district, I heard from those with chronic conditions about the debilitating prices of lifesaving medications. I heard from young families who are rationing their insulin between parents and kids. And I heard from local pharmacists who repeatedly experience the heartbreaking moment when a patient simply can’t afford their medication and walks away from the counter.

But listening to these stories is not enough. Right now, lawmakers need to recognize that there are immediate steps we can take to help build a sustainable path toward cheaper drugs for all Americans.

One of the first steps in bringing down prices is to demand transparency from the many players throughout the prescription drug supply chain. People are being gouged — but often, they don’t have any idea as to why they’re being gouged every single time they go to the pharmacy.

Within this chain, many experts point to pharmacy benefit managers (PBMs) as potentially contributing to rising list prices and out-of-pocket costs. PBMs are the veritable middlemen of the drug industry — they serve as intermediaries between drug manufacturers, health insurers and pharmacies. Some believe that during this process, drug makers are forced to raise the list prices of their drugs, just so they can offset the costs of rebates paid to these PBMs.

In 2016, PBMs saw an estimated $22.6 billion in gross profits. And right now, the three largest PBMs in the United States — Express Scripts, CVS Caremark and Optum Rx — control three-quarters of the supply chain.

But while these powerful PBMs continue to rake in large profits and maintain control of a massive chunk of the prescription marketplace, everyday families and seniors still struggle with the burden of skyrocketing drug costs. And PBMs continue to leave American consumers and pharmacists in the dark about how their operations could be contributing to high prices.

To begin shedding light on the black box of prescription drug negotiations, I introduced the Public Disclosure of Drug Discounts Act alongside my House colleagues Reps. Jodey Arrington (R-Texas) and Brendan Boyle (D-Pa.). Our legislation would require PBMs to publicly report their aggregate rebates, discounts and other price concessions.

PBMs are already providing this information to the U.S. Department of Health and Human Services (HHS), but our bill would require them to post these details to a public, easily-accessible website. The public would have more information to determine how rebates are affecting them.

The issue of PBM transparency is not a hyper-partisan issue — and that was clear when the U.S. House passed our bill by an overwhelming margin of 403 to 0. That’s a vote count that should signal just how common high drug prices are in House districts across the country, and I’m encouraged by Democrats and Republicans both recognizing the pressing need for our legislation.

Following the strong passage of our bill out of the House, HHS Secretary Alex Azar indicated his support for our bipartisan bill. I’m hopeful that with continued signs of good-faith support from the administration on this issue — as well as cooperation from Republicans and Democrats — we can make tangible progress on understanding the economic effects of decisions made by PBMs. And with this information, lawmakers can better hold PBMs accountable for any practices that are passing on price increases to America’s families and seniors.

This bill is not a silver bullet in the fight to lower drug costs, of course — but it’s a commonsense move to demand greater transparency regarding the murky practices of PBMs. As part of a larger push to address rising prescription prices, this increased market transparency would help patients, doctors, employers and other buyers better understand and compare the discounts PBMs receive from drug manufacturers.

American consumers are long overdue for Congress to finally make bipartisan progress on lowering prescription drug costs, and I’ll keep fighting on behalf of Central Virginia as I work to boost transparency across the pharmaceutical industry.

Spanberger represents Virginia’s 7th District.

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