Pharmacy Benefit Managers (PBMs) play a large role in how Americans receive their medication – processing nearly 80% of all U.S. prescriptions – but these middlemen have remained in the shadows and largely out of the view of regulators and consumers.
The good news is Congress is considering legislation that would limit PBMs from engaging in deceptive tactics like "spread pricing," in which PBMs charge health plans a percentage more than they pay pharmacies for a drug and keep the difference. This practice not only increases the price of the treatment but incentivizes pushing higher-priced medications. Measures are also being considered that would require PBMs to reveal how rebates, fees, and any other discounts are accounted for with pharmacies, health plans, and patients.
Alongside PBM reform, measures to place reasonable limits on the use of step therapy or "fail first" policies that require patients to try and fail on a lower-cost drug before they are allowed to access the drug originally prescribed by their physician are being considered. These reforms would protect the patients' prescribed treatments that work for them from being forced into a less effective or potentially harmful treatment for non-medical payer protocol.
Tell your representatives in Congress you support these measures to expand access to affordable medication for patients living with rheumatic disease and to prevent unnecessary delays to doctor-prescribed care.