Improving Access to Medications Should Be a Congressional Priority

By Alice Heiman
Yesterday, 09:49 AM

I’ve dealt with a lot of medical challenges throughout my life. It is exhausting, disheartening, and overwhelming at times. It’s also been a lifelong crash course in the pitfalls of our health care system in the United States, and what I’ve learned isn’t pretty. As anyone who has tried to regularly access health care in this country knows, being exhausted, disheartened, and overwhelmed isn’t just a symptom of illness; it’s a direct consequence of trying to navigate our dysfunctional health care system. It’s even harder in rural Nevada where medical facilities and pharmacies are scarce.

In few places is this clearer than when it comes to prescription drugs. I’ve taken a variety of medications over the years to deal with medical issues. Unfortunately, to receive the prescription drugs I rely on, I need to go to a compounding pharmacy (which are becoming more and more scarce in Nevada) as the corporate pharmacy doesn’t carry what I need. Even worse, my insurance will not cover the costs.

While I appreciate that President Trump is trying to address drug costs, I don’t believe the Most Favored Nation Executive Order will fix the root problems. This plan could kill future development of new drugs, and making matters worse, it does nothing to address the abuse of pharmacy benefit managers (PBMs).

PBMs are the rogue middlemen in the prescription drug supply chain, operating between drug manufacturers, chain pharmacies, and large insurers. While PBMs have flown under the radar in Congress, they have a surprising amount of control in our health care system, and instead of using this to help people, they only look out for their own interests and leave struggling patients to fend for themselves.

At the top of the list of PBMs’ misdeeds is their regular practice of absorbing savings intended for patients back into their profits. Even though PBMs receive large discounts and rebates on medications, they don’t share those savings with patients. That means that patients are often left paying more than they should at the pharmacy counter, which only exacerbates the access issues many Americans already face.

We can’t just stand by and watch greedy middlemen pad their profits at the expense of patients and drive-up prescription drug costs for all Americans. We need more transparency and accountability with PBMs, and I have seen that there are practical, bipartisan solutions in Congress that can lower drug costs and help patients immediately.

I urge our Federal legislators to pass PBM reform this year, and the best way to do this is by passing the PBM Reform Act, which was recently introduced by Congressman Buddy Carter. Hopefully, Nevada’s congressional delegation will lead the way on this issue and deliver a big win for patients in Nevada.