Pharmacy benefit managers vs. firefighters: Crack down on middlemen who drive up the cost of prescription drugs
New York Daily News
Firefighters put their lives on the line daily to run into burning buildings and limit property damage.
The 18,000 hardworking men and women represented by the New York Professional Fire Fighters Association work in departments across New York State and respond to more than a million calls each year, ranging from structure fires to multi-vehicle accidents and medical emergencies.
Like all workers, these brave men and women feel the squeeze of rising health-care costs and the dangerous spike in prescription drugs. Every day, news reports reveal new horror stories of people struggling to stay alive because they cannot afford their desperately needed medication.
That’s why we urge Gov. Cuomo to immediately sign a bill that has passed both houses of the state Legislature that would prevent pharmacy benefit managers (PBMs) from using “utilization management” tools, such as step therapy (often called “fail first”) and non-medical switching, to deny or delay access to prescription drugs for things like pain management and cancer treatment.
In some cases, these bad practices on the part of PBMs can even be fatal. These life-and-death decisions should be left to doctors — not profit-oriented corporations.
Pharmacy benefit managers are middlemen who make money by pushing certain drugs and treatments — often favoring policies that delay access to necessary and prescribed drugs in order to favor experimental options that cost the PBMs less.
The protections in the just-passed legislation would ensure that hard-earned health benefits are preserved for all workers, empowering doctors, not profit-motivated middlemen, to make medication decisions. A recent state Senate committee investigation found that a “lack of transparency” and weak oversight allowed PBMs to “engage in self-dealing to the detriment of consumers across New York State” without transparency or proper oversight.
This bill would ban PBM policies that restrict patient choice and devalue New Yorkers’ health plans. The problems are most acutely felt by the working men and women who support families on good union wages and benefits. All too often, they encounter roadblocks to getting the drugs they need despite having good health plans through years of collective bargaining.
The legislation requires PBMs to register with the Department of Financial Services by April 1, 2020 and be licensed by Jan. 1, 2021. DFS would regulate PBMs and monitor them for conflicts of interest and deceptive practices and anti-competitive practices.
PBMs’ most insidious “utilization tools” are step therapy — also known as “fail first” — and non-medical switching. These policies ignore the advice of doctors and put medical decisions in the hands of bureaucrats whose major aim is to make money.
The Community Oncology Alliance, a non-profit that advocates for affordable care for cancer patients and want to get PBMs “out of the loop,” cites countless “horror” stories of patient interactions with PBMs that are needlessly dragged out and occasional lead to more serious illness or even death.
We have all have endured years of attacks on organized labor. Workers must not be forced to suffer further reductions in quality and affordable care foisted upon them by corporations who put profits before protection.
Fresina is president of the New York State Professional Firefighters Association.