WASHINGTON, D.C. – U.S. Representatives Abigail Spanberger (D-VA-07) and Jodey Arrington (R-TX-19) introduced bipartisan legislation to tackle the prescription drug affordability crisis, hold pharmacy benefit managers (PBMs) accountable, and lower drug costs for American patients.
A 2020 Gallup poll showed that nearly nine in 10 U.S. adults were concerned about rising drug costs amid the COVID-19 pandemic. And according to a report released earlier this year, pharmaceutical firms increased prices on a record-breaking 905 brand-name prescription drugs in the month of January 2021 alone.
In the face of these rising costs, many independent experts are concerned that the practice of using PBMs as the middlemen between drug manufacturers, health insurers, and pharmacies is contributing to rising prescription drug prices and increasing out-of-pocket costs for American patients. In 2016, PBMs took in an estimated $22.6 billion in gross profits as consumer drug costs skyrocketed. And right now, the three largest PBMs in the United States — Express Scripts, CVS Caremark, and Optum Rx — control nearly three-quarters of the U.S. prescription drug supply chain. However, pharmacists are unable to see the rebates and discounts received by these powerful PBMs, meaning consumers are unable to learn more about how PBMs could be benefiting from rising drug prices and increasing their out-of-pocket costs.
The Improving Transparency to Lower Drug Costs Act would help hold PBMs accountable by requiring PBMs to report their aggregate rebates, discounts, and other price concessions for prescription drugs to a public website. This increased level of market transparency would help patients, pharmacists, employees, and business owners better understand and compare the discounts PBMs receive from drug manufacturers. Additionally, this transparency would allow Members of Congress to take further action to lower drug costs.
“As we rebuild and recover from the COVID-19 crisis, prescription drug costs remain a major concern for Central Virginia families and seniors. Since arriving in Congress, I have heard heartbreaking stories about how high prices have forced many of our neighbors to make difficult financial decisions. To fix this urgent issue, we need to strengthen transparency and accountability among PBMs,” said Spanberger. “For too long, prescription drug negotiations have been a black box — and as PBMs continue to rake in massive profits at the same time as Central Virginia families are struggling to pay for lifesaving medications, we need to shed light on how PBMs are potentially causing prices to rise. Our legislation would give the American people more information about how PBMs affect the price of prescriptions at the counter, and I’ll keep working to advance legislation that can increase competition, lower costs, and make prescription drugs more affordable for all Central Virginians.”
“For too long, patients have been kept in the dark on prescription drug prices and forced to simply accept skyrocketing costs of medication. Negotiations between PBMs and drug manufacturers are shrouded in secrecy, and PBMs are given free rein to claw back payments from our mom-and-pop pharmacies who simply don’t have the margins to weather these unexpected demands,” said Arrington. “This legislation will shed much-needed light on our drug supply chain and empower patients with more information about the cost of their medications.”
The Spanberger-Arrington legislation is endorsed by the National Community Pharmacists Association.
“The byzantine, manipulative behavior of PBMs has been catching up with them, but greater transparency into the games they play with drug rebates is still needed. Too many patients continue to suffer due to PBM shenanigans, and too many pharmacies have been wiped out as a result of drug payment system pressures. We’re pleased to endorse the Improving Transparency to Lower Drug Costs Act reintroduced by Reps. Spanberger and Arrington and support their efforts to rein in the PBMs,” said B. Douglas Hoey, Pharmacist, MBA, CEO of the National Community Pharmacists Association.
This bipartisan effort builds on the success of Spanberger and Arrington in working to hold PBMs accountable and increasing transparency in prescription drug price negotiations. In 2019, the U.S. House passed similar bipartisan legislation from Spanberger and Arrington — the Public Disclosure of Drug Discounts Act — by a vote of 403 to 0, and provisions from this legislation were signed into law by President Trump in December 2020.