Pharmacy middlemen are threatening access to drugs and keeping prices high

This op-ed originally ran in The Buffalo News.

As a patient who relies on life-saving medications from my local pharmacy, losing access to these treatments could jeopardize my health and leave me scrambling for affordable alternatives in an already complex health care system. The unchecked influence of pharmacy middlemen has increasingly threatened this access.

Called Pharmacy Benefit Managers (PBMs), these corporate players make getting a prescription even harder — and more expensive. The grip PBMs have over my health care, and that of millions of other patients, must be reined in by federal lawmakers.

PBMs — intermediaries between insurers, pharmaceutical companies, and pharmacies — are virtually unknown to most who walk into a drugstore. While they were originally created to negotiate drug prices to help reduce costs for patients like me, PBMs have expanded to dominate the pharmaceutical supply chain, influencing what drugs are available—and what I pay for them.

The prices negotiated between PBMs and drug manufacturers are a secret, leaving patients in the dark about why their prescription costs are so high. Each time I go and refill my prescriptions, my wallet gets pinched, and I have no way to challenge or verify the fairness of these costs.

I’m not alone. Expenditures on medicine in the U.S. have ballooned three-fold since the year 2000. And over that time, just three PBMs have gobbled up roughly 80 percent of the prescription drug market.

If costs weren’t burdensome enough, trying to secure certain medications with PBMs in charge is like reaching into a magician’s hat—you never know what you’ll pull out.

These middlemen are empowered to exclude certain drugs from being covered by insurance providers, which directly affects my ability to access the medications prescribed by my doctor. Too many times I’ve experienced the frustration of needing a specific drug, only to find it is no longer coveredor its price has skyrocketed thanks to these backroom deals.

PBMs also jeopardize the close relationships that patients have built with their pharmacists. If my pharmacy were to close down, I would be forced to travel greater distances to fill prescriptions. And worse, I would lose a healthcare advocate who knows my medical history and provides personalized care, which is often absent in larger chain pharmacies.

Fortunately, some states — including New York — have enacted strict regulations to curb PBMs’ influence. But while it’s a step in the right direction for independent pharmacies in my state, neighboring areas like Pennsylvania continue to face record pharmacy closures. Further, even when states act to curb abusive PBM practices, they do not have the authority to address a federal program like Medicare. That is why it is imperative that Congress take action now.

Congress must also hold these shady middlemen accountable, too. Sen. Chuck Schumer — in his role as Senate Majority Leader — should make it a priority to push legislation that would curb the monopolistic practices of PBMs.

Doing so would ensure that the drug supply chain serves the health of patients rather than the profit margins of corporate middlemen.

Patients like me depend on accessible and affordable prescription drugs, and it’s time our policies reflect that necessity. I urge Sens. Schumer and Gillibrand to take decisive action and support current federal legislation that loosens the stranglehold Pharmacy Benefit Managers have on our health care system.