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Opinion: It’s Giving Season but Pharmacy Middlemen Are Taking Everything

Pharmacy Benefits Managers, PBMs for short, are the healthcare middlemen, negotiating drug prices and pocketing substantial profits in the process. They often get paid based on the price of medicines covered by pharmacies. As a result, they may favor placing higher cost medicines under insurance programs over lower cost alternatives.

To make up the difference for pharmacies, consumers must often pay more out-of-pocket costs based on the full list price instead of the negotiated net price, multiplying the expenses. Because of these agreements, the average out-of-pocket spending for Americans has grown 58% over the past decade. PBMs keep taking our hard-earned money and we need a solution from our Congress to prevent further PBM abuses.

Change will come with the passage of the Patients Before Middlemen Act (HR 2880). This bill amends Section D of Medicare to combat PBM abuses on medications needed by the elderly and disabled populations. It is vital that this bill be implanted to prevent further imposing on our elderly and disabled Americans who are forced to pay the fees. Medicare patients paid almost quadruple more than those not covered under Medicare. This is absurd.

HR 2880 will implement a flat fee for each negotiation that will “delink” PBM earnings. By delinking their profits, PBMs will no longer be incentivized to negotiate for the most expensive medications, resulting in more reasonable fees for consumers.

While HR 2880 is vital to stopping some PBM abuses, it does not go far enough, and we must find solutions for all Americans. To reiterate, spending has more than doubled for all Americans. We are subject to PBM pricing, and no person deserves to be gouged by their tactics.

Consider your children, your spouse, your friends, and family. We at the Missouri Grocers Association consider our members family. We have heard from retailers, manufacturers, and grocery employees alike who have all described their issues with paying for their medication. We value each of our employees and must look out for them by dismantling the practices of PBMs.

This effort to reign in PBMs is finally making some traction but we must see it through in its entirety I urge all members of the Missouri Congressional delegation to support HR 2880 and to propose legislation for expanded coverage to fight PBMs.