Here’s how to get rid of the pharma middlemen | Column

This year, committees in both the U.S. House and Senate have been reviewing prescription drug reform legislation. If this important subject is given consideration and acted on, it could have life-changing implications for patients nationwide.

A key element of necessary reform should be — must be — reeling in the detrimental power of pharmacy benefit managers (PBMs). These pharmaceutical middlemen insert themselves between patients, health insurance providers and drug manufacturers — and have done so for decades. Their involvement hikes up the price of prescription drugs and limits access to care for patients across the country.

This potentially landmark step in the federal debate was, at least in part, propelled by states like Florida that have prioritized reform over the last year. As a sponsor of state-level legislation that garnered unanimous bipartisan support — a rarity in these divided times — I believe the prospect of national reform is not only well within reach, but absolutely necessary.

With many states working this year to rein in PBMs, there is finally a real push for Congress to enact meaningful reforms at the national level. In recent months, congressional committees on both sides of the Capitol have prioritized the review of bills with the same overriding goal: making sure patients are the ones profiting — not PBMs.

Opponents of reasonable reforms have argued that the legislation would be bad for businesses — but as a member of one of the nation’s most business-friendly legislatures, I can tell you that the kind of PBM reform we passed in Florida will actually help businesses save money as they provide coverage for their employees.

Historically, many large employers have contracted with PBMs to negotiate greater savings on prescription drugs for their employees. Over time, however, the prescription middlemen haven’t held up their end of the bargain — instead of passing savings along to employers and consumers, they have diverted the savings and pocketed the profits for themselves.

It may seem that one of the loudest voices opposing PBM reform has been businesses, but the reality is that reform is good for business — it’s just that PBM groups are really good at getting a megaphone to their message.

That’s why numerous groups are speaking out from the business perspective and setting the record straight. The national EmployersRx Coalition, for example, provided testimony during the U.S. Senate Finance Committee’s hearing on PBM reform. Summing up its members’ frustration with the lopsided system crafted by PBMs, the coalition said in a statement: “Despite being the primary customers for PBMs and even some of the country’s largest companies and purchasers of health care — employers are no match against PBMs’ significant market power.”

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Seven of the nation’s largest business groups, along with many others, believe PBM reform will protect consumers from predatory practices, without creating a stifling bureaucracy. Reform starts with actionable steps, and they are on Congress’ docket for consideration. It’s important that our national leaders recognize the desires of the people and embrace some of the reforms already being made in individual states.

First, Congress must enact strong transparency and cost reporting requirements. With mandated reporting to health plans, federal agencies and the Federal Trade Commission, PBMs would no longer be able to hide their activities in the shadows, but will be forced to bring them into the light.

We need to also see national limits on spread pricing to mitigate price gouging, and Congress should require that PBMs pass through 100% of rebates and administrative fees, and the American public needs transparency regarding PBM-owned pharmacies — when PBMs own their own specialty pharmacies, they operate unchecked.

This year, our federal leadership has the opportunity to enact real change for patients and take a hard look at the deception happening daily in our health care system.

With some of the largest employer groups in the nation joining the broad coalition of physicians, pharmacists and patients calling for reform nationwide, it’s time for Congress to follow the lead of the states and stand with the people.

Nationally, we must prioritize putting patients first.

State Rep. Linda Chaney, a Republican, represents the St. Petersburg area in the Florida House of Representatives. She served on the Florida House Healthcare Regulation Subcommittee and sponsored Florida prescription drug reform legislation.