And greater transparency and competition are necessary, agreed Members of Congress and witnesses during a Republican-only forum on the Role of Pharmacy Benefit Managers in Pharmaceutical Markets held by House Committee on Oversight and Reform.
“PBMs have consolidated from more than 20 regional and national players, to 3 that control roughly 80% of the market,”said Ranking Member James Comer (R-KY). “Every major PBM owns or is owned by a specialty, mail-order, or retail pharmacy, or all three.”
This consolidation and vertical integration has led to higher costs: “only the highest priced interchangeable insulin can gain formulary access; other, cheaper biosimilar insulins are kept off formulary,” said Dr. Madelaine Feldman of The Rheumatology Group in New Orleans.
It also diminishes choice, as PBMs limit independent pharmacy participation and engage in patient steering, said Tiffany Jones of specialty pharmacy Senderra. “Sick and vulnerable patients are threatened that they will lose coverage of drugs if they don’t comply” with requests to transfer prescriptions back to the PBM’s owned pharmacy, she said.
Step therapy, or the idea that patients must “fail first,” can harm patients further: “You basically have to have two violent attacks of vomiting before you get the drug that could have stopped it in the first place,” said Ted Okon of the Community Oncology Alliance.
Rebates have more than doubled over the past decade—but they aren’t getting to patients,explained USC’s Dr. Erin Trish. “While this has helped keep Part D premiums low, it means that beneficiaries pay more out-of-pocket at the pharmacy counter.”
In addition to greater transparency and competition, we need to pass rebates to patients at the pharmacy counter—watch to learn more.
Why it matters: The House is getting ready to pass drug price controls, yet “Democrats have decided to limit their drug pricing investigation to only pharmaceutical companies leaving a significant void in in the Oversight Committee’s review of drug pricing and many unanswered questions,” said Ranking Member Comer—read the Republicans’ forum wrap-up.
Visit www.SaveCures.com to learn more about drug pricing proposals and tell your Members of Congress how we can lower costs for patients without harming future cures.
More News:
The New York Times: U.S. plans to spend billions to increase COVID vaccine supplies
“The White House, under pressure to increase the supply of coronavirus vaccines to poor nations, plans to invest billions of dollars to expand U.S. manufacturing capacity, with the goal of producing at least one billion doses a year beginning in the second half of 2022.”
Twist Bioscience: Twist Bioscience launches Revelar Biotherapeutics to develop and commercialize novel COVID-19 and other antibody therapeutics for difficult to treat diseases
“We look forward to having our first Twist Biopharma-discovered antibody enter clinical studies in 2022, pending the necessary requirements,” said Dr. Emily M. Leproust, CEO and Co-Founder of Twist Bioscience.
Informa Pharma Intelligence: Khushboo Sharma: improving regulatory science, from industry to FDA and back
“When Khushboo Sharma left the FDA to join the Biotechnology Innovation Organization (BIO) in April 2021, as VP of science and regulatory affairs, she ended an 11-year stint at the agency with several notable accomplishments. ‘One of the things that I really wanted to do at FDA was be a part of the user fee negotiations,’ said Sharma, who worked most recently as deputy director for operations at the Center forDrug Evaluation and Research’s (CDER) Office of New Drugs (OND).” (Paywall)
