Prioritizing Patients Rather Than Pointing Fingers

If Thursday’s Senate Finance Committee hearing on pharmacy benefit managers is like most prescription drug-related conversations on the Hill, the session will be boiled down in news coverage to descriptions of finger-pointing between the #PBMs , pharmacy groups and drug manufacturers. While true in some part, this garden-variety political shorthand unfortunately minimizes what’s truly important in the discourse.

But this hearing feels different and it’s off to a good start. Both Chairman Wyden and Ranking Member Crapo appreciate that, at this moment (or any in the day), there are likely dozens of patients at the pharmacy counter who are completely confused about how any of this opaque system works. What the National Pharmaceutical Council cares about—and what we all should center in our minds—are the impacts this system has on patient out-of-pocket costs, which directly translates into Americans being able to get the medicines they need.

For more than a decade, insurers and their self-contained PBMs have engaged in an arms race over copays and deductibles. You’re probably familiar with the chain of events: copays go up, manufacturers offer assistance, insurers draft schemes to take those away, manufacturers look for a work-around ... you get the picture.

At the end, there’s that person at the pharmacy counter simply trying to figure out a way to pay for a prescription they need to maintain or improve their health.

What I’m looking for from Congress and the Federal Trade Commission—and what we’re working toward at NPC—is more insight into this complex and increasingly opaque system which has a significant impact on pricing, patient access and even sites of care. It is time to re-align incentives so they tilt toward value, patient affordability and access—and away from creating revenue streams for middlemen.

The status quo is geared primarily to contain drug costs, often ignoring the individual need of the patient and, thus, the potential that other cost offsets could materially improve health outcomes. That latter part—better health—ought to be the ultimate goal.

Hearings fill chairs on the Hill, but what this discussion needs is an infusion of high-quality research and analysis that helps public and private payors improve health benefit design, begetting good value and better health for everyone.

That’s what NPC does and we’re willing to work with anyone willing to focus on what’s truly happening and its impact on patients, so people who need medicines can stop being pawns in the game.