As Congress works to lower health care costs, we are reaching a critical point in our nation’s debate over what consumers should pay for prescription drugs. The current Senate budget reconciliation package is hyper-focused on cutting drug prices. Unfortunately, the legislation is short-sighted, ignoring an important remedy that would help reduce out-of-pocket costs for drugs.
The reconciliation package does not include reforms for pharmacy benefit administrators — or PBMs — something many lawmakers, including Ohio Senator Sherrod Brown, have been working on in recent years. sen. Brown and colleagues are working to apply the knowledge discovered in recent years about PPE misuse practices to develop better public policies that will lower drug costs for patients.
PPE is an important part of the drug supply chain. Auditing three PPE companies more than 75% of the market and these companies continue to adapt their business practices in a way that generates more revenue for them – rather than lowering patients’ out-of-pocket costs.
in 2018, The Columbus Shipment began a deep dive into PPE practices. The Dispatch, Ohio Capital Journal and other news outlets continue to report on how PBMs are driving up costs for major public payers like Medicaid, employing unfair and unpredictable reimbursement practices that bankrupt many independent pharmacists, and increasing out-of-pocket costs for patients.
Investigations by the Ohio news media uncovered the practice of “spread pricing,” showing that PBMs took in about $225 million more from the state than pharmacies were reimbursed for their services to Ohioans using Medicaid benefits.
Oncology providers are increasingly dealing with a health plan practice called “white bags”‘, which happens when a plan requires patients to get their cancer medications from a mail order or specialty pharmacy owned or affiliated with that plan’s PBM. This form of pharmacy management can seriously disrupt patient care.
Patients forced to use a PPE mail-order or specialty pharmacy must now wait for drugs to come from that source, rather than have the oncologist, who may have the necessary drugs in stock and ready to use, begin taking them immediately. the treatment.
Oncology providers across the country can describe the extreme frustration not only with the delay in patient care, but also with the drug waste that occurs as a result of white bag policies.
The behavior of PPE now has the attention of the Federal Trade Commission, whose members recently voted to investigate some PPE practices. Given this research and recent exposure in the news media and other analysts of pharmacy public policy, state and federal officials are much more informed about the role PBMs play in driving up drug costs.
Congress must do everything possible to ensure that patients can afford to pay for their medications and receive treatment in a safe and timely manner. This requires a more thorough package that prioritizes policies such as copay caps for chronic conditions and reforms of PPE practices.
For oncologists and cancer practices across the country, who have taken the lead in demonstrating the impact of PPE on cancer-fighting patients, we expect better.
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