Josh Hawley Confronts PBM CEO on Skyrocketing Drug Costs

PBMs and Drug Affordability

• 🎯 Josh Hawley questions Juan Carlos Scott, CEO of the Pharmaceutical Care Management Association (PCMA), about whether PBMs are succeeding in making drugs cheaper for patients.
• 💡 Scott claims success in managing net drug costs but cites escalating drug company list prices as a challenge.
• 📉 Hawley presents data showing Americans pay significantly more for brand-name drugs compared to other countries, questioning PBM negotiation effectiveness.

Business Model and Patient Impact

• 🏥 Hawley argues that the current benefit design primarily benefits insurance companies and PBMs, not patients, leading to unaffordable insulin and basic medications.
• 💰 He highlights that the top three PBM companies generated $7.3 billion in profits between 2017 and 2022, questioning why patients still struggle with costs.
• 📈 The FTC report is cited, indicating increased profits for PBMs.

Competition and Consolidation

• 🤝 Hawley proposes breaking up the alliance between insurance companies and PBMs, noting that the largest PBMs are owned by the largest insurance companies.
• ⚠️ He points to the closure of independent pharmacies, with two counties in Missouri having zero pharmacies, despite PBM profits.
• 🚫 Scott opposes legislation to prevent PBMs from owning pharmacies, arguing for market optionality.

Market Dynamics and Accusations

• 📊 Scott claims competition has grown in the PBM market, citing an 18% increase in the last 5 years.
• 🚫 Hawley refutes this, stating the biggest three PBMs control 80% of the business and are owned by major insurers, calling it a "racket" that harms patients.
• 🛒 Accusations are made that PBMs direct patients to their owned pharmacies through special rebates and lower costs, forcing patients to pay more if they use independent pharmacies.
• ✅ Dr. McG confirms these practices are occurring.