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Hope you enjoyed the holiday weekend. We’re back with BIO’s Bio.News series on the problems with PBMs, plus a recap of BIO’s IP Counsels Committee Conference and more news you need to know. (573 words, 2 minutes, 51 seconds) |
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Putting patients first: BIO explains why we need PBM reform |
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As pharmacy benefit managers (PBMs) prioritize profits, patients suffer, says BIO in the first two installments of a Bio.News series on PBMs.
Why it matters: PBMs choose which drugs receive insurance coverage, and profit from keeping drug prices high. They’re often integrated with pharmacy chains and insurers, with three PBMs controlling 80% of the market.
The step therapy problem:Step therapy requires patients to prove cheaper alternatives do not work before PBMs allow them to take the drug their doctor initially prescribed. One study found that rheumatoid arthritis patients exposed to step therapy did 19% worse than patients whose choices weren’t constricted.
A legislative fix: Patient groups and others support legislation to “ensure that employer-sponsored health plans offer a timely and medically reasonable step therapy exceptions process.” The legislation has advanced in the Senate.
The rebate problem: Drug manufacturers give PBMs rebates, essentially trading pricing concessions in return for better patient access. PBMs say nearly all rebates are passed along to employer and health plan clients, but those claims are questionable, and fees can hide profits.
A legislative fix: Bills before Congress include a provision calling for a “rebate passthrough” to guarantee that no funds are diverted from health plans and back toward PBMs.
Read more about the challenges with step therapy and rebates at Bio.News.
Listen here to a first-hand account of a patient's experience with step therapy.
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What happened at the BIO IP Counsels Committee Conference
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Rep. Deborah Ross (D-NC) addresses the opening session of BIO’s Intellectual Property Counsels Committee Conference on Nov. 18. |
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What Else to Read This Week
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ICYMI: November was National Family Caregivers Month. The Caregivers Action Network (CAN) highlighted the role of caregivers in improving clinical trial diversity: “Someone mowing their lawn is a caregiver just as much as someone that is picking up medication from the pharmacy, or someone that is educating themselves on clinical trials and following through with influencing or helping to share decision making with their loved one,” CAN CEO Marvell Adams Jr. told Bio.News.
A UN report released yesterday for World AIDS Day highlights progress: “Fewer people acquired HIV in 2023 than at any point since the late 1980s. Almost 31 million people were receiving lifesaving antiretroviral therapy in 2023, a public health success that has reduced the numbers of AIDS-related deaths to their lowest level since the peak in 2004.” Gilead announced its own major advance: a Phase 3 clinical trial showed twice-yearly lenacapavir reduced HIV infections by 96%.
Bitter veggies like kale, mustard greens, and brussels sprouts are really good for you—but some people can’t stand the taste. Enter gene editing. National Geographic explores how food and biotech companies—including Pairwise and Bayer—are using CRISPR Cas-9 to research how to make these foods tastier while keeping the health benefits. |
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Beltway Report: What's Ahead in Washington
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Hope you enjoyed the long holiday weekend. The Senate Health, Education, Labor & Pensions Committee is planning a hearing, “What Is the FDA Doing to Reduce the Diabetes and Obesity Epidemics in America and Take on the Greed of the Food and Beverage Industry?” on Thursday. |
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