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David Balto Sends Letter to HELP Committee Regarding Need for PBM Reform

The letter states that in crafting legislation to benefit taxpayers and consumers and erect long-needed guardrails on the PBMs that dominant and distort the marketplace, I would suggest that the committee consider the following ideas:

· Mandate that negotiated rebates by passed on to plan sponsors and patients. We should never forget that the original intent of involving PBMs in drug price negotiations was to reduce costs for patients at the pharmacy counter. The committee has an opportunity to reinstate that founding mission by insisting that PBMs pass along all rebates and discounts they negotiate.

· Eliminate the connection between PBM compensation and the price of a drug. Nothing could be more anti-consumer than a drug supply chain that has built-in incentives to force patients into using higher-priced pharmaceuticals. PBMs should be paid a flat fee for their intermediary services and not have their revenues linked to the list price of a drug.

· Put an end to the formulary gamesmanship. Legislation should prohibit drugs from being excluded from formularies or placed in a disadvantageous position on a formulary in the name of boosting PBM profits. One of the most important actions Congress can take is preserving the sanctity of the doctor-patient relationship by ensuring that medication decisions are based solely on a patient’s health needs.

· Help endangered independent pharmacies. PBMs often pay pharmacies fees that are below the pharmacies’ cost in acquiring the medicine. This needs to stop, as do all discriminatory practices that favor PBM-owned pharmacies and put independent community businesses at a severe disadvantage.

Read the letter in its entirety.

Letter to Senate HELP Committee 4.21.23
Download PDF • 92KB

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