Ted Okon: Pressure Is Mounting on PBMs

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.