Activity to regulate pharmacy benefit managers (PBMs) has started in the states and is trickling up to the federal level, said Ted Okon, MBA, executive director of the Community Oncology Alliance.
Pharmacy benefit managers (PBMs) have been under increased scrutiny over the last few years regarding practices that have been driving drug prices. What has started with regulation at the state level is now trickling up to the federal level with bipartisan support for something to be done, said Ted Okon, MBA, executive director of the Community Oncology Alliance (COA).
In 2020, the case of Rutledge v PCMA from Arkansas opened the floodgates for banning the practice of white bagging, in which the PBM mandates patients receive their drugs from the PBM’s affiliated pharmacy instead of the oncologist’s on-site pharmacy. This practice often delays care for the patient because it may not be shipped in time for an appointment or it may be on time, but the drug cannot be used if the oncologist has to make any adjustments, explained Angela Storseth-Cooper, director of government relations and public policy, The US Oncology Network, at an Institute for Value-Based Medicine® event cohosted by The American Journal of Managed Care® and Texas Oncology.
Okon noted that the pressure has been building on PBMs and if there was ever a year for both parties and both chambers of Congress to come together and pass a bill regulating PBMs, it would be this year.
Transcript
There are multiple bills making their way through Congress aiming to dismantle pharmacy benefit managers' control of patient care. Which of the proposed reforms has the best chance to pass Congress and become a law?
So, there's been a lot of activity at the state level, and there's even more in terms of regulating PBMs. But now we're finally seeing a trickle-up to the federal level. There are actually 22 bills that have to do with some facet of PBMs. I think the good news is there's so much of an awareness—not only in the House but in the Senate, not only among Republicans but among Democrats—that something has to be done with PBMs.
I think the challenge is twofold. Number one, the current environment in the Congress is very challenging, just to begin with, especially as we go towards the year end… So, it's a little challenging to see how these come together. But if there's ever the likelihood that PBM legislation will come about in both the Senate and the House and signed into law, it's this year.
The pressure is really mounting on these PBMs they feel it. They are launching, you know, mega million advertising campaigns and everything else. So, this is a big, this is a big deal. And we at COA are pushing. We've been pushing now for five years on PBMs. And we're seeing some good results.
Tackling Health Inequality: The Power of Education and Experience
April 30th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our final episode of this limited series and our conversation with Janine Jelks-Seale, MSPPM, director of health equity at UPMC Health Plan.
Listen
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Latest Advances and Updates of Treatment in the Real World at AUA
May 1st 2024The annual meeting of the American Urological Association (AUA) not only presents the newest therapies coming out but showcases the latest in how treatments are being used in the real world, said Stephen Freedland, MD, of Cedars Sinai.
Read More
OptumRx’s Jon Mahrt Discusses “Irresponsible” Drug Pricing for Products With Multiple Indications
April 30th 2024When the same product comes to market with additional indications, irrational pricing decisions result in ever increasing prices instead of volume translating to lower costs, said Jon Mahrt, MBA, of OptumRX.
Read More