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Opinion: PBM reform act will result in worse outcomes for patients and businesses

Washington, DC – The Pharmacy Benefit Manager (PBM) Reform Act, led by self-described socialist Sen. Bernie Sanders (D-VT), raises serious concerns about the United States inching closer to a system of socialized healthcare. The bill proposes extensive government regulations within the private healthcare market, which could disrupt the private agreements that are instrumental in fostering competition, providing affordable options for patients, and enabling businesses to offer comprehensive benefits to their employees.

PBMs play a crucial role in the American healthcare landscape. They are instrumental in promoting competition, resulting in reduced costs for patients. Unfortunately, the PBM Reform Act would limit the choices available to businesses when selecting lower-cost options for their healthcare plans. Consequently, patients’ access to affordable healthcare is restricted and businesses will have limited tools to negotiate favorable healthcare plans for their employees, undermining their competitiveness in the marketplace.

The proposed restrictions in the PBM Reform Act would lead to increased healthcare expenses, placing a heavier strain on businesses by imposing higher out-of-pocket costs for prescription drugs, elevated premiums, and deductibles. This approach disregards the challenges already faced by American businesses to provide affordable healthcare coverage for their employees. It undermines their ability to allocate resources effectively and inhibits their capacity to attract and retain talent in an increasingly competitive market.

Claims that the current PBM system lacks competition is unfounded. Currently, there are 73 PBMs operating throughout the country, with no regulatory barriers preventing new entrants. The presence of prominent entrepreneurs like Mark Cuban and major corporations such as Walmart actively working to establish their own pharmacy benefit networks demonstrates the opportunity for competition and innovation within the PBM sector.

Further, the impact of PBMs on drug prices has undergone rigorous scrutiny by government agencies over the past two decades. The Government Accountability Office’s 2019 report unequivocally concluded that PBMs provide substantial savings for Medicare Part D beneficiaries. Additionally, a Federal Trade Commission report found that prices at PBM-owned mail-order pharmacies were generally lower compared to independent mail-order and retail pharmacies.

Opponents of PBMs must recognize that federal agencies have conducted thorough reviews and examinations to evaluate the PBMs effect on drug prices. These evaluations consistently demonstrate that PBMs save money for patients and businesses alike. It would be counterproductive to hinder this successful cost-saving aspect of the healthcare system, as proposed by the Bernie Sanders PBM Reform Act. Such interference would only lead to increasing pharmaceutical costs, jeopardizing the financial stability of both patients and businesses.

Congress should advocate for solutions that foster free-market competition and innovation, ensuring that all Americans have access to affordable healthcare while supporting business growth and economic prosperity. The PBM Reform Act undermines these principles and threatens to move us closer to a system of government-controlled healthcare. It is crucial that Sens. Josh Hawley and Eric Schmitt (R-MO) reject this bill and instead support policies that prioritize patient choice, preserve private agreements, and empower individuals and businesses to navigate the healthcare system independently, while maintaining financial stability and promoting a thriving business environment.