Starting the conversation about pharmacy benefit managers
Specific legislation to address the problem of high copayments for specialty drugs, the Patients’ Access to Treatments Act (H.R. 2999), would establish cost-sharing limits and prevent insurers from using drug formulary specialty tiers to limit access to needed therapies. It has been the ACR’s marquee legislative target for the past three Congresses, and its champion, Rep. David McKinley (R-W.Va.), has introduced the bill several times. “The ACR remains committed to increasing patient access to therapies that help our patients control their potentially disabling diseases like rheumatoid arthritis,” Dr. Worthing said.
Concerns about drug pricing and the practices of pharmacy benefit management (PBM) companies, were a high priority for the ACR’s September Advocates for Arthritis Capitol Hill visits and were discussed in several sessions. Advocates’ concerns about access to high-cost drugs for their patients threatened by rebates and other PBM practices have now been taken up by Congress.
Drug pricing issues were aired in a series of hearings by the Senate Committee on Health, Education, Labor and Pensions. At a hearing in October, both Democratic and Republican committee members asked questions about high drug prices and the effects of rebates, and called for greater transparency in PBMs’ pricing practices. “These hearings are critical, because they are helping get the conversation started about PBMs,” Dr. Worthing said.
Larry Beresford is a freelance medical journalist in Oakland, Calif.
Reference
- Bernstein S. Rheumatology’s future: The 2015 Workforce Study reveals rising gap between rheumatologist supply & patient demand. The Rheumatologist. 2017 Feb;11(2):49,54–56.
