U.S.
senators
and
representatives
introduced
a
bill
on
Wednesday
that
aims
to
prohibit
the
combined
ownership
of
pharmacy
benefit
managers
(PBMs)
and
pharmacies
and
require
parent
companies
of
PBMs
to
divest
their
pharmacy
businesses.
The
bill
is
called
the
Patients
Before
Monopolies
Act
(PBM
Act)
and
was
introduced
by
Senators
Elizabeth
Warren
(D-Mass.)
and
Josh
Hawley
(R-Mo.)
with
Representatives
Diana
Harshbarger
(R-Tenn.)
and
Jake
Auchincloss
(D-Mass.).
It
comes
as
PBMs
—
particularly
CVS
Caremark,
Cigna’s
Express
Scripts
and
UnitedHealth
Group’s
Optum
Rx
—
face
scrutiny
from
the
Federal
Trade
Commission
due
to
being
vertically
integrated
with
large
healthcare
conglomerates.
The
FTC
argues
that
PBMs
have
major
power
over
which
prescription
drugs
are
available
and
at
what
price,
and
sometimes
steer
patients
to
their
affiliated
pharmacies
over
independent
pharmacies.
To
prevent
this,
the
bill
would:
-
Prohibit
the
parent
company
of
a
PBM
or
insurer
from
owning
a
pharmacy
business -
Mandate
that
a
parent
company
violating
the
PBM
Act
must
divest
its
pharmacy
business
within
three
years -
Allow
the
FTC,
Department
of
Health
and
Human
Services,
DOJ’s
Antitrust
Division
and
state
attorneys
general
to
order
violators
of
the
act
to
divest
their
pharmacy
business
and
return
any
revenue
earned
during
the
violation
period -
Direct
the
FTC
to
allocate
disgorged
funds
to
affected
communities,
including
consumers
overcharged
at
vertically
integrated
pharmacies -
Require
all
divestitures
to
be
reported
to
the
FTC,
which
can
review
these
actions
and
any
subsequent
acquisitions
to
safeguard
competition,
financial
stability
and
public
interest
“PBMs
have
manipulated
the
market
to
enrich
themselves
—
hiking
up
drug
costs,
cheating
employers,
and
driving
small
pharmacies
out
of
business.
My
new
bipartisan
bill
will
untangle
these
conflicts
of
interest
by
reining
in
these
middlemen,”
Warren
said
in
a
statement.
Hawley
echoed
Warren’s
comments,
stating
that
insurance
monopolies
are
harming
American
healthcare.
“Patients
and
independent
pharmacies
are
paying
the
price,”
Hawley
said
in
a
statement.
“This
legislation
will
stop
the
insurance
companies
and
PBMs
from
gobbling
up
even
more
of
American
health
care
and
charging
American
families
more
and
more
for
less.”
The
PBM
Act
also
has
support
from
several
advocacy
groups
and
healthcare
organizations.
It
is
endorsed
by
the
American
Economic
Liberties
Project,
AffirmedRx,
Patients
Rising,
National
Community
Pharmacists
Association,
American
Pharmacy
Cooperative
Inc,
and
Pharmacists
United
for
Truth
and
Transparency.
Unsurprisingly,
the
PBM
advocacy
group
Pharmaceutical
Care
Management
Association
came
out
against
the
bill,
arguing
that
it
would
limit
access
to
“safe
and
affordable
pharmacies.”
“The
truth
is
PBM-affiliated
pharmacies,
including
mail-service
and
specialty
pharmacies,
have
a
proven
track
record
of
providing
convenient,
reliable,
and
affordable
options
for
patients
to
access
prescription
drugs,”
said
JC
Scott,
president
and
CEO
of
PCMA,
in
a
statement.
“Mail-service
pharmacies
could
save
patients,
employers,
and
public
health
plans
$23.5
billion
over
10
years
and
specialty
pharmacies,
which
are
sometimes
affiliated
with
PBMs,
have
the
technology
and
clinical
expertise
to
enhance
the
quality
of
care
patients
receive,
and
typically
can
reduce
the
cost
of
extremely
expensive
specialty
drugs
by
up
to
45
percent.”
This
is
not
the
first
bill
with
bipartisan
support
that
aims
to
rein
in
PBMs.
Others
include
the
Pharmacy
Benefit
Manager
Transparency
Act
and
the
Modernizing
and
Ensuring
PBM
Accountability
Act.
The
FTC
has
also
recently
sued
CVS
Caremark,
Express
Scripts
and
Optum
Rx
over
insulin
prices.
The
PBMs
responded
by
countersuing
the
agency
in
November,
claiming
the
FTC’s
lawsuit
is
unconstitutional.
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