Former Governor, Broad Coalition of Patients, Patient Advocates, Independent Pharmacists and Others Bring Concerns about PBMs to Beacon Hill
For Immediate Release:
June 6, 2023
BOSTON, MA – Today, members of the Patients Not PBMs coalition, and others, brought their significant concerns about Pharmacy Benefit Managers, or PBMs, to the State House with testimony before the Joint Committee on Healthcare Finance. The committee heard testimony on several pieces of legislation relating to pharmaceutical access, cost and transparency, including PBMs.
Lauren Hunt has direct, personal experience with PBMs not only driving costs up but actually preventing her from even accessing medication for juvenile arthritis, a debilitating condition which she has suffered with since childhood, and which requires specialty prescription drugs. Her mother, former Governor Jane Swift, testified about the experience of helping her daughter navigate a complex and frustrating maze of phone calls, emails and time spent trying to secure access to medication her daughter needs.
“No family can ever be prepared for all the challenges life comes at us with -- I know that all too well. But this isn't about what my daughter did or I did. This is about a system that fails to protect vulnerable patients across the Commonwealth every day,” said Governor Jane Swift. “Massachusetts policymakers have an opportunity to change this – to lead on this issue, as we have on so many healthcare matters - so that PBMs are finally held accountable, and families have access to the lifesaving medicines they need.”
“In a few short years, other members of Gen Z will begin thinking about health care more intensely as they have children and care for elderly parents, or perhaps develop their own health care needs,” said Lauren Hunt. “The Massachusetts legislature is considering several bills to rein in the PBM industry and to restore some power to consumers who rely on life saving medications that they provide. Our state can take a few steps, such as passing these regulatory bills, and make the promise of access to critical health services a real attraction for my generation. We are paying attention.”
Also testifying today was Todd Brown, Executive Director of the Massachusetts Independent Pharmacists Association, which represents most independently owned pharmacies across the Commonwealth.
“Our current system is broken. It lacks transparency and accountability,” said Todd Brown. “PBMs are using their outsized market share to steer patients toward preferred retail pharmacies, resulting in many independent pharmacies having to shutter their doors.”
“As a patient, simply knowing more about the problem doesn’t help much,” said Erin Callahan, Chief Operating Officer of the Diabetes Patient Advocacy Coalition (DPAC), who has been living with type 1 diabetes for 36 years. “Adding rebate reform legislation is one way to create meaningful impact for people living with chronic conditions immediately.”
Additional background: PBMs act as middlemen between the manufacturers of prescription medication and patients as well as small independent pharmacists. For years, PBMs have been driving up health care costs, pocketing rebates for themselves with little accountability or transparency – and there is finally bipartisan momentum to address the problem once and for all.
The “big three” PBMs – Express Scripts, CVS Caremark, and OptumRx, owned by UnitedHealth Group – control over 80 percent of the market, covering roughly 180 million prescription drug customers. PBMs are supposed to negotiate benefits with drugmakers, formulate the list of approved medicines (“drug formularies”) that health plans could use and process claims and transactions in real time. But because of a persistent lack of oversight and accountability they instead collect tens of billions of dollars in rebates and discounts for themselves that would otherwise be passed on to consumers.
PBMs are some of the most profitable corporations that most Americans have never heard of. In 2021 alone, rebates, discounts and payments made by drug manufacturers to PBMs and insurers totaled $236 billion, but PBMs and insurers kept much of the rebate dollars for themselves.
Why It Matters: For years, policymakers in Massachusetts and at the federal level have been turning over every stone imaginable to lower healthcare costs. They have pushed hospitals, drugmakers, insurers and so many others, with little success. But with PBMs’ complete lack of transparency and example after example of them driving costs up billions of dollars every year, it appears that bipartisan momentum is finally growing to rein in PBMs once and for all.
Massachusetts is at the forefront of these efforts. Earlier this year, Patients Not PBMs, a coalition of patient advocacy organizations, independent pharmacists and local business groups, was formed to push for legislation to force transparency around pharmacy benefit managers, or PBMs, and their impact on drug costs. Several bills have been filed in the Massachusetts legislature that would require PBMs, who act like middlemen, to be more transparent, stop keeping rebates intended for patients and reimburse pharmacies fairly.
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Contact:
Eileen O’Connor
eileen@keyserpublicstrategies.com
c: 617-806-6999
