Following Friday’s announcement by President Trump of the signing of four new Executive Orders aimed at reducing the price of prescription drugs for Americans, Pharmacists United for Truth and Transparency (PUTT) is cautiously optimistic that some of these Executive Orders will result in the fulfillment of promises made by the President two years ago.
While we are most hopeful for the Executive Order “prohibit(ing) secret deals between drug manufacturers and pharmacy benefit manager middlemen, ensuring patients directly benefit from available discounts at the pharmacy counter” we respectfully ask the Trump Administration to consider the following questions:
Despite numerous studies on the role of rebates in drug pricing — the most recent published in 2020 — PBMs have managed to not only thrive in the closed market U.S. healthcare system, but have come to dominate it through a series of highly-contested vertical mergers resulting in the consolidation of the insurance provider, the pharmacy benefits designer, the physicians, and the pharmacies. In absolutely no case did these mergers fulfill their promise for lower costs and better healthcare delivery, but in fact had the opposite effect — most notably the acquisition of PBM Caremark by CVS Health in 2006. In many situations, U.S. consumers have seen their drugs’ list prices increase while the net price remained stable year over year, the most famous cases being Mylan’s EpiPen and Eli Lilly’s Humalog.
The PBM business model must be reformed to ensure PBMs act as fiduciaries to the plan sponsor and not as middlemen “rent-seekers” exploiting a fragile system for their own profit gain. For true drug price reform to occur, all forms of “pay to play” compensation between PBMs and drug manufacturers must stop. Ending rebates all together would move prescription care a step closer to a free market, where true market forces, including competition, would lower costs.
As pharmacists, we wholly believe every patient needs and deserves access to affordable medication. We offer our support of any programs that will create transparency so that all U.S. healthcare stakeholders can understand the supply chain dynamics and rationale for drug pricing. We do not support the importation of drugs from other countries, including Canada. We believe this practice will create false hopes for Americans, who will be disappointed with pricing that would be marginally less than what they currently pay, but would be a great deal cheaper if the PBM middlemen and their backroom deals were simply eliminated altogether.
PUTT and our members look forward to patients and providers having the right of quality, affordable access to medication restored, and to providers receiving the respect and level playing field to which they are entitled as medical professionals.