Congress Should Reform PBMs and Avoid Price Setting Policies that Threaten Medical Innovation

By Traci S. of New Jersey

    Being a caregiver to my husband over the past few years has been a harrowing and eye-opening experience—one that has made me value innovations and advancements in medical care all the more.


    Back in 2019, my husband came down with what at the time we thought was just the flu. However, one morning when I was about to leave the house, I checked in on him to find he was unresponsive. Due to an infected heart valve and blood infection we did not know about, my husband had suffered numerous strokes.


    He woke up one week later only to find that he had lost his ability to walk and talk. Over the next six months, he went through extensive physical and verbal therapy, and we are fortunate that he has made progress. However, I’m more concerned than ever that we could lose access to the lifesaving medical care that helps meet my husband’s needs today, let alone what needs he may face in the future.


    That is why we are both opposed to efforts in Congress to increase the amount of control the government has in setting prescription drug prices. Prescription price setting policies not only have a negative impact on the availability of certain drugs on the market today, but they can also restrict the resources that pharmaceutical researchers and scientists need to continue developing next-generation treatments and cures, including medications and therapies that could help my husband continue his journey of healing and recovery.


    If Congress truly wants to help improve patient access to care, then lawmakers in Washington should work to reform the harmful, anti-patient policies put in place and enforced by Pharmacy Benefit Managers (PBMs). Essentially health care middlemen, PBMs are owned by insurance companies and, while they claim they are there to help drive down costs, far too many of their practices actually increase out-of-pocket costs and decrease access for patients in need.


    Due to their lack of federal oversight and regulation, PBMs have grown to control a vast majority of the prescription marketplace. As a result, these middlemen are often the final say if a patient can actually access their doctor-prescribed treatments, and studies have found that last year alone, PBMs denied coverage to over 1,150 medications.


    Our family shouldn’t have to worry about my husband not being able to access the prescriptions he needs. Our only focus should be on his healthcare journey and not the anti-patient practices of unknown middlemen looking to make a profit.


    To me, it is just common-sense that Congress should focus on reforming PBMs, not threatening medical innovation by calling for more government prices setting.


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