A holiday wish: Congress must pass PBM reform
By WILLIAM MURPHY
William Murphy is Director, Advocacy & Public Policy, Epilepsy Foundation New England
As New Hampshire families plan for the holidays, many are making careful calculations – not about gifts or celebrations but how to afford their prescription medications. As a patient advocate working with Granite State residents, I hear from people every day who are struggling with prescription drug costs, not because of doctor’s fees or drug prices, but because of the abusive business practices of middlemen known as pharmacy benefit managers (PBMs).
These prescription drug middlemen have been under Congressional scrutiny all year, and for good reason. The Senate Finance Committee has crafted a comprehensive, bipartisan framework for reform that would transform how PBMs operate.
Their package includes critical policies to delink PBM compensation from drug list prices and ensure negotiated savings are passed directly to patients at the pharmacy counter. These proven solutions would help make medications more affordable for American families.
The problem is clear: three large PBMs control 80% of prescription drug benefits, operating with limited transparency while collecting profits at multiple steps. In our rural state, their policies have impacted local pharmacies and often require patients to use mail-order services or travel longer distances to “approved” pharmacies.
On behalf of the more than 13,100 people living with epilepsy in New Hampshire, and thousands of others living with chronic health conditions, Epilepsy Foundation New England encourages Congress to pass meaningful Pharmacy Benefit Managers (PBMs) reform. This is the opportunity to replace corporate greed with compassion and provide needed access and affordability to the lifesaving medicines that the epilepsy community relies on.
The Senate Finance Committee’s framework offers a clear path forward to addressing these concerns. Their comprehensive package would:
■End practices that incentivize PBMs to choose expensive drugs over affordable ones
■Require PBMs to pass negotiated savings directly to patients at the pharmacy counter
■Increase transparency in PBM pricing and practices
■Protect independent pharmacies from unfair fees and practices to keep them in our local communities
Some alternative PBMs already operate transparently, demonstrating these reforms are practical and effective. They provide employers with clear cost breakdowns, pass-through rebates, and allow patients to use their preferred local pharmacies. Their success proves that transparency and fair pricing are achievable.
The traditional PBMs’ arguments against operating transparently don’t align with market reality. While they’ve maintained profitable operations, families across New Hampshire continue struggling to afford necessary medications.
This isn’t a partisan issue. It’s about implementing practical reforms to improve medication affordability. The bipartisan Senate Finance package is ready. All we need for Christmas is for Congress to include these critical policies in an end-of-year package.
To our Congressional delegation: New Hampshire families need PBM reform in their stockings this year, not promises of action next session. The Senate Finance Committee has done the hard work of crafting bipartisan solutions. Now it’s time to deliver the gift of affordable medications by passing these reforms before heading home for the holidays.