Good Day BIO: Why we need to fix PBMs

Happy Monday. We have more details on Biden’s EO on addressing prescription drug prices—and what BIO says about it—as well as the UN’s just-launched One Health action plan. (652 words, 3 minutes, 15 seconds)

Want to address drug prices? Curb PBMs.

President Biden signed an executive order Friday directing Health and Human Services (HHS) “to explore additional actions it can take to lower prescription drug costs.” Here’s an idea: address pharmacy benefit managers (PBMs).

The executive order: “HHS will have 90 days to submit a formal report outlining any plans to use the Innovation Center’s authorities to lower drug costs and promote access to innovative drug therapies for Medicare beneficiaries,” per the EO.

But here’s the thing: “The Administration cannot truly address Medicare patients’ out-of-pocket cost concerns unless HHS reforms the shadow rebate market in which PBMs operate,” said BIO’s Chief Advocacy Officer Nick Shipley in a statement.

Remind me—what are PBMs? PBMs manage prescription drug benefits for insurance plans and payers. They’re often vertically integrated with insurance plans, and the three largest PBMs handle 80% of all prescriptions in the U.S.

The problem: PBMs receive rebates and discounts on drug prices, and they’re supposed to pass the savings to patients—but they often don’t, and in fact limit access via formulary exclusions. 

“To increase access and reduce patient out-of-pocket costs, BIO has expressed support to HHS and [the Innovation Center] to bring transparency to the broken rebate system responsible for inflating costs as well as explore innovative payment models that bring financial relief to patients,” continued Shipley.

The bottom line: “Rather than playing politics with America’s seniors and most vulnerable, we look forward to working with this Administration and lawmakers in a pragmatic way to ensure access and affordability of medicines and other health care needs is a priority,” concluded Shipley.

Want to learn more?  Listen to the I am BIO podcast--Drug Prices: A Dysfunctional Market Limits Patient Access

UN launches One Health action plan

The UN’s four key health and agriculture agencies today launched the first-ever One Health Joint Plan of Action, “a framework to integrate systems and capacity so that we can collectively better prevent, predict, detect, and respond to health threats.” And it couldn’t come at a better time.

“One Health is the main approach for addressing the complex health challenges facing our society, such as ecosystem degradation, food system failures, infectious diseases, and antimicrobial resistance,” says the joint statement from the UN Food and Agriculture Organization (FAO), UN Environment Programme (UNEP), World Health Organization (WHO), and World Organization for Animal Health (WOAH).

Why it matters: From the worst bird flu outbreak in the U.S. in years to the growing risk of the next pandemic being caused by drug-resistant bacteria or perhaps an emerging disease we may not even know about yet, we face a rising number of health threats increasingly linked to our relationship with animals and the environment—and made worse by climate change.

“The five-year plan (2022-2026) focuses on supporting and expanding capacities in six areas:

1. One Health capacities for health systems,
2. Emerging and re-emerging zoonotic epidemics,
3. Endemic zoonotic, neglected tropical, and vector-borne diseases,
4. Food safety risks,
5. Antimicrobial resistance, and
6. Environment.”

“It all starts with ensuring the health of animals,” said WOAH Director-General Dr. Monique Eloit. And this should start with biotech solutions—like gene editing to make poultry and pigs resistant to deadly diseases.

“One Health should start from proper land management and stopping deforestation, which will help people and their animals in the surrounding environment,” added FAO Director-General QU Dongyu—and biotech can help here too, with tools like gene editing crops to withstand disease and climate change, or addressing soil salinization.

Download the UN’s plan.

Read more about biotech tools for agriculture and addressing climate change. 

Clarification:Friday’s email implied the purple tomato authorized by the USDA is a “gene-edited” crop, but the tomato is a genetically modified organism (GMO). Whether genetically modified or edited, however, we want to emphasize that biotech crops are safe and have an important role to play in feeding the world in a sustainable way—read more about GMOs and gene editing.

President Biden’s Monday: Returning to Washington today after spending the weekend in Delaware. With COP27 fast approaching, the Biden administration is pursuing deals to move toward a clean energy economy, reports Bloomberg.

What’s Happening on Capitol Hill: Recess.