What to know about the drug price fight in those TV ads

Ongoing debates and new legislation targeting prescription drug prices have spurred a flood of related TV ads, some of which are difficult to trace back to their sponsors.

Context on the ad sponsors: Several different groups are funding the advertisements.
* The Pharmaceutical Research and Manufacturers of America, which represents major drug companies, is leading an anti-PBM (Pharmacy Benefit Managers) campaign.
* Other ads have been sponsored by the PBM Accountability Project, a lobby group that includes unions and patient advocate groups whose members criticize restrictive PBM and insurance policies.

Understanding the role of PBMs: Pharmacy Benefit Managers play a major role in prescription drug pricing and access.
* Formed in the 1960s, PBMs are companies that help employers and insurers select and purchase medications for their health plans.
* With about 70 PBMs in the U.S., three of them — CVS Caremark, Optum Rx, and Express Scripts — control 80% of the prescription drug market.

Consequences of PBM power: Other health care sectors are alarmed by the power PBMs have.
* Critics, including employers, pharmacies and even patients, bristle at PBM practices like “spread pricing,” where companies pocket negotiated money meant for health plans.
* Doctors criticise PBMs for blocking or slowing coverage of necessary drugs.

Congressional response: Various bills aimed at curbing PBMs have been launched in Congress.
* Legislation under consideration includes measures to prohibit PBMs from collecting rebates and fees based on a drug’s list price, require PBMs to pass along discounts directly to seniors, and compel PBMs to provide more information about their financial practices.
* Some states have moved to lessen PBM-related costs using high-tech auctions to negotiate optimum deals for their employee health care plans.

Balancing views on PBMs’ role: While PBMs are criticized for their secrecy and power, some argue that they also play a crucial role in controlling drug prices.
* Dr. Benjamin Rome, a health policy researcher at Harvard Medical School, stated: “PBMs are the only thing we have to lower brand-name drug prices and prevent the drug industry from charging whatever they want.”
* However, Rome also expressed concerns about any new legislative structures and whether they would prove any better for patients.

View original article on NPR

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