What We're Reading: Congress Questions PBM Industry; Hospitals, MA Clash; Polio Risk in Gaza

Congress Considers Reforms to PBM Industry

Lawmakers concerned about high drug prices questioned representatives from pharmacy benefit managers (PBMs) during a Congressional hearing Tuesday, according to The Hill. PBMs’ job is to negotiate drug prices, manage pharmacy networks, and influence which medications patients can access. The industry blames drug companies for high prices, claiming they save patients money through negotiations. Lawmakers, however, are skeptical. A committee report suggests PBMs favor expensive drugs with high rebates, potentially steering patients away from cheaper alternatives. They also control a large share of the market and may incentivize using their own mail-order pharmacies over independent ones. Independent pharmacists argue these practices threaten their businesses. The Federal Trade Commission also recently raised concerns about anticompetitive behavior by PBMs. The hearing reflects growing pressure on PBMs, which lawmakers might use to push for reforms in upcoming legislation.

Hospitals, Insurers Clash as Private Medicare Grows

The number of hospital patients covered by private Medicare Advantage (MA) plans is rapidly increasing, according to Axios. This trend is causing tension between hospitals and insurers. Hospitals argue that MA plans pay lower rates and create administrative burdens by denying claims or requiring preapproval for care. This can lead to financial strain for hospitals and potentially higher costs for patients. As the number of MA enrollees grows, so does the power of insurers. Lawmakers are considering ways to address these issues, such as requiring faster review times for treatment approvals by MA plans.

Experts Fear Polio Is Spreading in Gaza

Public health officials are alarmed after poliovirus was found in sewage samples from Gaza, according to NBC News. The war-struck region has a crumbling health care system and poor sanitation, making it highly vulnerable to an outbreak. Vaccinations rates have dropped in Gaza, leaving many children unprotected as well. Humanitarian groups are scrambling to deliver vaccines and assess the scope of the problem. Experts have warned that time is critical as the virus could spread quickly in these conditions.