WAOPS signed on to a letter to Senator Baldwin regarding PBMs:

Dear Senator Baldwin,

We are aware that the Senate HELP Committee will be considering legislation to regulate pharmacy benefit managers on April 19, and we are writing to share what we would like to see from this hearing.

As you no doubt know, pharmacy benefit managers (PBMS) are prescription drug middlemen owned by insurance companies that leverage their place in the drug supply chain to reap huge profits for themselves while leaving patients with few options at the pharmacy counter. While better regulations targeting the frankly monopolistic practices of PBMs has been considered in the past, we would like to encourage you and your colleagues to move forward with bold and impactful new policies that will make a real difference for patients across the country.

Due to the fact that just three PBMs, OptumRx, CVS Caremark, and ExpressScripts, control 80 percent of the drug marketplace they have been able to engage in practices that don’t just cost money, but actively hurt patient access to medicines. Since PBMs manage drug formularies for insurance plans they are able to decide which drugs will be covered, and frequently they have given preference to higher cost medications because they can make more money off them than lower priced alternatives. PBMs are too often leaving low-priced generics and biosimilars off formularies entirely, which in turn drives up prescription drug costs and puts many drugs out of reach of the average patient. Additionally, PBMs are the vertically integrated through the ownership or management of many specialty and retail pharmacies. This integration allows PBMs to steer patients toward their own pharmacies in order to increase their own profits, even if their pharmacies are not convenient or preferred by the patient.

Action at the federal level must be taken to regulate PBMs and ensure they are working for patients not their own bottom lines. Strong transparency requirements should be implemented to PBM contracting practices so they can be monitored to ensure they are operating in the best interest of patients and not their own profits.

In Wisconsin, we have passed legislation requiring PBMs in the state to disclose what they pay for drugs and whether the savings on those drugs have been passed on to patients. This type of transparent accountability is critical to ensuring a more equitable drug supply chain. We cannot continue to allow PBMs to reap unprecedented profits thanks to a lack of transparency and accountability.

Recent litigation by several Attorneys General have found that hundreds of millions of dollars in government funding has been lost to PBMs thanks to their purposefully opaque business practices. The link between the price of a medicine and PBMs profits must be broken.

We hope you will remember our concerns during the upcoming HELP Committee and will support significant new regulations to ensure patients are being treated fairly and can more easily access the medications they need.