How PBMs Hurt Patients
These PBMs are more than just middlemen between drug companies and patients. In fact, they control not only what medications patients can access, but also at what cost. Consequently, their predatory practices create significant obstacles for patients trying to afford necessary medications. Moreover, PBMs prioritize profits by employing tactics such as spread pricing and rebate schemes. As a result, this raises drug costs while simultaneously limiting competition. Therefore, to protect patients, we must end PBM predatory practices.
Real Patient Stories: The Impact of PBM Predatory Practices
Patients across the country suffer from this broken system. Sarah, a 32-year-old with rheumatoid arthritis, watched her medication costs jump from $50 to $500 per month. Her PBM moved her drug to a higher tier. “I had to choose between paying rent and managing my pain,” she said. This story shows the harmful impact of PBM predatory practices.
Michelle, a cancer survivor, faced a similar problem. Her PBM made her pay $60 for a prescription that cost only $40 without insurance. “Why should using my insurance make the medication more expensive?” Michelle asked. This kind of pricing manipulation is another example of PBM predatory practices.
John, a diabetic, was forced to switch to a less effective insulin. His PBM removed his preferred brand from the formulary. “I spent months trying to stabilize my blood sugar levels,” he said. Stories like John’s highlight the urgent need to end PBM predatory practices.
Lack of Transparency in PBM Predatory Practices
PBMs make secret decisions about which drugs to cover or exclude. This lack of transparency leaves patients in the dark. Patients are often denied access to life-saving medications or face higher costs without knowing why. Maria, a 55-year-old cancer survivor, was hit hard by these practices. Her PBM put all cancer drugs in the highest-cost tier. “It felt like I was being punished for having cancer,” Maria said. Her struggle shows why it’s time to end PBM predatory practices.
A Call for Reform
Patients Rising is committed to stopping these practices. We applaud the House Oversight Committee for taking on this issue. Today’s hearing is an important step toward exposing PBM actions and pushing for reforms that put patients first.
One solution is the DRUG Act (Delinking Revenue from Unfair Gouging). This bill aims to end PBM incentives for favoring expensive drugs. By separating PBM revenue from drug prices, we can take a big step toward ending PBM predatory practices.
Other reforms include more transparency in drug coverage decisions. We need to stop unethical practices like “lasering” and adverse tiering. Open formularies that give patients access to all FDA-approved generics and biosimilars at lower costs will also help. Finally, we need greater oversight to limit PBM control over drug pricing and access.
A System Built for Patients, Not Profits
The American healthcare system should work for patients, not PBMs. Patients should not have to choose between their health and financial stability. We must end PBM predatory practices and build a system that prioritizes patient well-being.
The fight to end these practices is not over. But with lawmakers, advocates, and informed patients, there is hope for real change. Millions of Americans depend on it.
Join the conversation: How have PBMs affected your access to medications? Share your story with us at Patients Rising and help us advocate for the change we need.