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The Implications of Pharmacy Benefit Managers Prioritizing Profit Over Patients



Juliana Reed, MS, executive director of the Biosimilars Forum, discussed the recent United States Senate Finance Committee hearing regarding biosimilars, titled “Pharmacy Benefit Managers (PBMs) and the Prescription Drug Supply Chain: Impact on Patients and Taxpayers.”


Reed, along with the Biosimilars Forum, is concerned with the limited access to lower-cost biosimilars, specifically regarding the 8 adalimumab biosimilars set to launch in July, due to PBMs controlling access to 80% of the US market. The PBMs have only included several adalimumab biosimilars on their formularies, which led Reed to question what kind of access will be given to the remainder. The PBMs' actions limit competition, which is a concern for the Federal Trade Commission investigating the anti-competitive practices of PBMs.


Moreover, she stated that the PBMs prefer high rebate/high list price biosimilars, which goes against the ideology of developing biosimilars to launch at lower prices to create competition and lower healthcare costs. She argued that the PBMs' actions are anti-biosimilar and prevent competition and lower healthcare costs and that the actions of the PMBs prevent the development of biosimilars that can help patients and save money.


“The PBMs require a high rebate, preventing low-priced biosimilars from being on their formulary, which limits access and increases out-of-pocket costs for patients,” Reed explained.


Reed is pleased to see that the Senate Finance Committee, the House, and the Commerce Committee are looking into the issue. However, in her opinion, transparency is not enough.


“We have evidence that the PBMs on the [adalimumab] biosimilars are requiring medically unethical decisions by a physician before the patient can have access to a biosimilar,” Reed stated. “They are requiring that a patient fail on the reference Humira before they can have the biosimilar, which is medically unethical… That's another way that they're limiting competition and access to lower cost products.”


Although she is optimistic about the hearing, she emphasized her concerns regarding the PBMs controlling access to competition in the marketplace, which may impact the overall destiny of the market’s future.


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