PBMs drive drugs cost up, run Ohio pharmacies out of business. Brown must get answers.
Dave Burke serves as executive director of the Ohio Pharmacists Association and is a former member of the Ohio House of Representatives, Ohio Senate, and pharmacy owner for 23 years.
To lower the cost of prescription medicines, reforms must happen across the entire drug supply chain.
In recent weeks, Ohio Sen. Sherrod Brown held events across the state and highlighted the value of local, independent pharmacies and the struggles they face.
This is significant because Brown has supported federal proposals to address how pharmacy benefit managers impact pharmacists, particularly independent pharmacies that serve rural and urban communities as well as underserved areas of the state.
Brown and some of his colleagues rightly want to stop the unfair and borderline punitive PBM practices that create unpredictable fees for pharmacists, in addition to increasing out-of-pocket costs for patients.
Too many Ohio independent pharmacies have been forced to close their doors, largely because PBMs impose unfair and inadequate compensation for the prescription medications dispensed.
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Why are PBMs problematic?
PBMs are the most influential player of the medication supply chain.
When first initiated, PBMs existed to process prescription drug claims. Now, PBMs influence virtually every aspect of prescription drug cost and accessibility.
PBMs decide what medicines will be covered, where and how patients obtain medications, how much pharmacies are reimbursed for dispensing prescriptions, and what the cost sharing requirements are for consumers.
It’s important to recognize that the top PBM companies are owned by the some of the largest health insurers in the nation.
What actions must Sherrod Brown take?
Lawmakers, consumer groups, and patient stakeholders are deeply concerned with the outsized influence of PBMs, including PBMs’ revenue streams which are taken largely from the savings they negotiate with drug companies instead of having those savings benefit patients and employers. Brown and colleagues have an opportunity to uncover more about questionable PBM practices, during a hearing in the Senate Finance Committee.
The Committee has summoned executives from UnitedHealth Group to testify about the recent cybersecurity hack that resulted in patient security breaches, disrupted access to care and medication, and led to significant delays with payments and reimbursements.
While UnitedHealth Group is one of our nation’s largest insurers with access to vast amounts of patient data, it is also the parent company of one of the nation’s largest PBMs, Optum Rx. I hope Sen. Brown will take this opportunity to question company officials about some practices of UnitedHealth Group’s PBM as well as the cyberattack.
UnitedHealth Group’s PBM Optum RX reported 2023 revenues of $116.1 billion.
For perspective, that is more revenue for 2023 than IBM, Ford and CSX Rail reported for 2023…..combined.
Together with two other PBMs, they control 79% of the PBM claims market. Because of its considerable size, UnitedHealth Group can control almost all facets of healthcare services and patient access to such services.
Brown rightly supports an investigation by the Federal Trade Commission to examine the vertical integration and market domination of the PBM companies.
I urge Brown to advance efforts to better understand the nontransparent practices within PBMs. Please use the opportunity of the upcoming Senate Finance Committee meeting to ask questions and hold responsible those who could initiate meaningful changes that will ultimately benefit patients and local pharmacy providers.
Dave Burke serves as executive director of the Ohio Pharmacists Association and is a former member of the Ohio House of Representatives, Ohio Senate, and pharmacy owner for 23 years.
This article originally appeared on The Columbus Dispatch: Sherrod Brown must get to bottom of PBMs dodgy practices at hack hearing
