Pharmacy benefit managers should be praised for helping to keep down the cost of prescription drugs, rather than being attacked by Congress and others, according to one health policy adviser.
April Ponnuru, a senior adviser with the Conservative Reform Network, told American Pharmacy News that spending on prescription drugs is dropping, and that pharmacy benefit managers (PBMs) should be recognized for playing a key role.
Her op-ed piece for the Washington Examiner explaining her reasoning comes as Congress contemplates two bills targeting PBMs, the middlemen who negotiate prices of drugs paid by both private insurers and Medicare Part D.
"The case for PBMs helping to keep drug prices down can be inferred from the trends that CVS and ExpressScripts are reporting and which I reference in the piece, which is that consumer spending on prescription drugs is on the way down," Ponnuru said.
Two bills, one each in the House and Senate, were filed this year, largely centering on the transparency of PBMs, including how much of any rebate or price negotiated with drug companies is passed on to the insurance companies and employers. In addition, congressional hearings have been held on the role of PBMs in the drug supply chain.
Some politicans, including former presidential candidate Sen Bernie Sanders (I-VT), want the government to have a more direct role in negotiating Medicare Part D prices. Ponnuru disagrees with that position.
She told American Pharmacy News, "Medicare Part D enjoys high levels of customer satisfaction and comes in well under budget: for a government program, that’s pretty impressive."
In the opinion piece, Ponnuru described the "dramatic improvement in the quality of prescription drugs over the past few decades is nothing short of a modern-day miracle.
"More and more Americans are successfully managing chronic illnesses — illnesses that often resulted in hospital stays and shorter life expectancy not so long ago — with medication," she wrote. "While it's true that this progress often comes at a high cost, the private market is actually doing a remarkably good job at keeping overall costs in check."
Ponnuru also claimed Medicare Part D's success has not insulated it from attack, citing a 2014 proposed rule change that she claimed would have inserted the federal government into the process. It would have limited the number of prescription-drug plans an insurance company can offer and put an end to the preferred pharmacy networks that dramatically reduced costs for America's seniors, said Ponnuru.
Critics claim the preferred pharmacy networks, where consumers are limited in the number of pharmacies they can use, limits competition, and particularly hurts independent pharmacies.
In March, pharmacy benefit manager CVS Health reported that prescription drug spending for its customers increased at the slowest rate in 4 years — by only 3.2 percent — with more than one-third of their large business customers actually paying less for medicines in 2016 than they did in 2015, Ponnuru noted in her opinion piece.
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