Patients and caretakers in Nevada and throughout the country are fed up with having to deal with greedy insurers that own and control pharmacy benefit managers (PBMs) who only seem to care about protecting their profits. While legislation in the Nevada Legislature like Senate Bill 316 could be a great first step in reforming PBMs, we still need our congressional delegation in Washington to stand up for Nevada patients before it’s too late.
The dishonest tactics and unfair practices these multi-billion-dollar groups use to control the prescription drug marketplace have weakened access to the medications that Nevadan’s need. PBMs are siphoning off the prescription drug savings that could be used to help reduce out-of-pocket expenses for patients. We’ve all heard about manufacturers offering rebates on prescription medications, but I’ve never felt any benefit from those rebates.
Rural Nevadans who require more specialized medications are negatively impacted even more as we have seen local pharmacies, and especially compounding pharmacies, continue to close all around the state as PBMs remain unregulated and push out competition.
Like millions of other patients, I’m tired of being quiet and just taking abuse from PBMs while our elected officials in Washington do next to nothing to stop it. If lawmakers in Congress or any of their family members had to go through what my family has been through, then maybe we’d see legislation passed to reform unfair PBM practices and policies. That shouldn’t be what it takes to get lawmakers to act, but so far, nothing else seems to be working. Its time we all speak out and say “enough!”
Unfortunately, even though Congress has worked to confront drug costs for patients, most notably through the Inflation Reduction Act (IRA), this law may do far more harm than good. The IRA aims to lower prescription drug costs for seniors by allowing Medicare to negotiate prices on certain high-cost medications. However, it fails to address the role PBMs play in inflating drug prices.
Moreover, the IRA’s “pill penalty” potentially harms the research and development of small molecule (or pill form) drugs by shortening the window before these drugs are up for negotiation. By reducing the critical investments into these drugs, the Inflation Reduction Act makes it more challenging for patients to receive the care we need. This is especially concerning for patients who suffer from Alzheimer’s, Parkinson’s, and rare genetic disorders that come in pill form. Since the IRA discourages investment into small molecule drugs, companies may pivot away from developing them, which could kill the hopes of future innovation combatting these diseases.
Without action, the pill penalty may undermine the IRA’s intent to help patients by potentially limiting options for those suffering from chronic, life-threatening conditions. I hope our leaders will reform this error by passing the EPIC Act and instead focus on vital PBM reform before they run out of time to do so.
It’s critical we pass reforms that help lower patients’ out-of-pocket costs, but it’s even more important that lawmakers go after the right culprit. Any missteps could have disastrous consequences for Nevada’s patients.
Sheila Lambert resides in Las Vegas.
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