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Free2Care Leader & Constituent Sends Letter to Sen. Casey Urging Support for PBM Reform

Dear Senator Casey,

I am writing to you as a constituent, a Philadelphia area pediatrician with two dozen years practicing, co-founder of the Practicing Physicians of America and leadership in Free2Care coalition, representing 8 million citizens nationally. For decades patients have been getting less and paying more, causing them to frequently skip appointments, medications and needed care.  

Specifically, the prescription drug benefit system is fundamentally flawed and requires immediate repair. The practices of large middlemen corporations, known as pharmacy benefit managers (PBMs), have significantly driven up healthcare costs for employers while impeding patients’ access to essential medications. More than ever, we need impactful legislation in Congress to rein in the harmful practices of PBMs and implement real savings at the pharmacy counter for all Americans.

A number of states have taken the lead in enacting PBM reform legislation to address some of the most egregious practices that have harmed consumers, taxpayers, and small businesses. Now, it is time for federal solutions to tackle this national problem head-on. It is concerning to note that just three PBMs control over 80% of the prescription drug marketplace. Furthermore, their mergers with large health insurers and ownership of specialty and retail pharmacies have bestowed upon them significant power without adequate accountability. When insurers and PBMs have merged, the PBM have served as the revenue drivers, exposing their role as healthcare cost-drivers.

The financial burden of patients is compounded by the shadowy rebate deals struck between PBMs and drug manufacturers, which steer consumers toward higher-priced medicines to maximize PBM profits at the expense of patients. While Free2care supports PBM transparency created by the Pharmacy Benefit Reform Act, we must go further.

To be blunt, transparency alone in the PBM space merely allows patients to see clearly how much they have been getting fleeced by PBM and the insurance companies who now own them.

The newest bipartisan effort in the Senate, the Patients Before Middlemen (PBM) Act, takes that extra step and delinks PBM compensation from drug price and utilization. This will align incentives that will help lower prescription drugs costs for Medicare Part D beneficiaries. Kudos to Senate Finance Chairman Ron Wyden (D-Ore.), Senate Finance Ranking Member Mike Crapo (R-Idaho) with U.S. Senators Bob Menendez (D-N.J.), Marsha Blackburn (R-Tenn.), Jon Tester (D-Mont.), Roger Marshall (R-Kan.) for taking that extra step. 

Recently, the CEO of CVS, the parent companies one of the largest PBMs announced their confidence in working around the intended impact of legislation by creating new methods to increase their profits. In other words: They believe their revenue streams are untouchable. They believe they are untouchable, and they will find new ways to create more wealth for themselves while draining the pockets of sick, vulnerable and hard-working Americans . 

I ask you to support the Patients before Middlemen Act and to continue to support the Pharmacy Benefit Reform Act. In addition, I ask you to press your colleagues at the Senate level and your Pennsylvania delegation to do the same  

I have no doubt that PBMs, insurers, and all those who profit from the current status quo will vehemently oppose any legislation aimed at addressing the high cost of medications. We have seen this before when AARP opposed 85% of its members who supported rebate reform. Understand that they are protecting their royalty profits from United healthcare. However, it is most essential for Congress to protect patients, including the AARP members, who bear an immeasurable cost in health and an unseen cost to their pocketbook.

The drug pricing system is in need of a serious overhaul, and patients across the country are counting on Congress to act now to make it happen. Patients are watching. My physician colleagues are watching. Do the right thing for PBM reform.

Thank you for your consideration,

Marion Mass, M.D.
Practicing Physicians of America, co-founder
Free2care leadership

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