Senator Hirono Criticizes Pharmacy Benefit Manager Delays Impacting Patient Care

Concerns Over Prescription Drug Supply Chain

• 💊 The prescription drug supply chain is identified as not competitive, largely due to vertical integration.
• ⚖️ A proposed bill to require the divestiture of PBMs owning pharmacies is discussed as a potential structural change.
• 🏛️ The Department of Justice (DOJ) and Federal Trade Commission (FTC) are encouraged to address antitrust issues related to vertical integration.

Issues with Pharmacy Benefit Managers (PBMs)

• 📉 Vertical integration within PBMs creates inherent conflict situations.
• 📊 Even with price transparency, a lack of power among entities working with PBMs renders transparency less effective.
• 💸 The practice of spread pricing by PBMs is questioned, with some states like Hawaii already eliminating it.
• 🤝 A pass-through PBM model, where clients pay what pharmacies are paid without spread or capture, is presented as a gold standard.

Impact on Patient Treatment

• ⚠️ PBMs are criticized for delays in approving necessary medications, leading to patients being in critical conditions, sometimes described as 'at death's door'.
• 🩺 PBMs may lack the expertise to quickly determine the most efficacious medication for complex treatments like cancer.
• ✅ Reforms are needed to ensure prior approvals are resolved quickly and effortlessly, rather than eliminated entirely.
• 🧑‍⚕️ While PBMs are a focus, other entities in the chain, including manufacturers and payer solutions, also contribute to drug access issues.