Photo credit: www.yahoo.com

Congress Faces Urgent Need for Prescription Drug Cost Reform

As the current session of Congress approaches its conclusion, lawmakers are under pressure to fulfill a crucial promise to the American public: reducing out-of-pocket costs for prescription drugs. With only a few weeks left before newly elected representatives take their seats, this legislative action has become increasingly urgent.

Lowering drug prices is an achievable goal, and it garners considerable bipartisan interest in both the Senate and House. Recent investigations have revealed concerning practices by pharmacy benefit managers (PBMs) that manipulate drug pricing to enhance their own profits, contributing to the climbing costs of medications. Several reform bills have already advanced through congressional committees, leaving the pivotal task of passing this legislation before the current Congress adjourns.

Residents of Texas, along with many Americans, are acutely aware of the flaws in the current prescription drug pricing system. The situation becomes particularly inequitable when PBMs negotiate discounts with drug manufacturers but do not pass those savings on to patients, instead charging co-pays based on the original pricing of medications.

The issue is exacerbated by findings from the Federal Trade Commission, which indicate that PBMs often steer patients toward costlier drugs that maximize their profit margins while stifling access to more affordable alternatives, like generics. This not only complicates the patient-physician relationship but also leads to inflated out-of-pocket expenses for vulnerable consumers, many of whom rely on fixed incomes.

The evidence of the harm inflicted by these practices is clear and well-established. Millions of Americans face ongoing repercussions from this flawed system. The immediate need for Congress to act decisively on this issue is paramount.

Two significant bills have already gained traction within the Senate Finance Committee: the “Modernizing and Ensuring PBM Accountability Act” and the “Better Mental Health Care, Lower-Cost Drugs, and Extenders Act.” The critical aspects of these reforms revolve around two key provisions.

Firstly, it is essential to sever the connection between PBM revenues and drug costs. When PBMs generate income through rebates tied to the list prices of drugs, it incentivizes them to promote higher-priced medications. A shift to a flat, market-based fee structure for PBM services would prevent them from profiting at the expense of financially challenged families.

Secondly, rebates secured by PBMs from drug manufacturers should be directly passed to patients at pharmacies, rather than being redirected into PBM profits. It is unacceptable for patients to pay full price when their medications are available at a discounted rate.

These proposals reflect practical, common-sense solutions that resonate across party lines. However, time is running out. The current Congress needs to prioritize these reforms; otherwise, any progress achieved will be lost and necessitate a fresh legislative effort in the new Congress, prolonging the financial strain on patients reliant on affordable medicine.

It is crucial for the Texas congressional delegation, along with the broader Congress, to prioritize the passage of PBM reform legislation. The opportunity to make significant strides in making prescription drugs more accessible must not be squandered.

Ford is president and CEO of the Texas Healthcare & Bioscience Institute.