Senator Tillis on PBM Reform: Past Failures and the Need for Modernization

The Problem with Current PBM Reform Discussions

• 🗣️ Senator Tillis argues that discussions around Pharmacy Benefit Managers (PBMs) often involve people talking past each other, focusing on a single target like pharma or PBMs without considering the entire value chain.
• 💡 This approach leads to spinning wheels and picking favorite targets instead of achieving meaningful reform.

Consequences of Policy Decisions

• 📉 Tillis points to the Affordable Care Act (ACA) as an example where, while pharma faced cuts, there was a 60% reduction in small molecule research, a critical field for future therapies.
• ⚠️ He questions why companies would publicly state such reductions if they were not genuinely impacted by policy decisions.

The Need for Transparency and Audit

• 🔍 Tillis highlights the difficulty in obtaining transparency, even from his own PBM, Tricare, for federal employees.
• 📝 He has repeatedly requested an audit of Tricare to understand pricing within the "black box" but has only received heavily redacted reports.
• 🏛️ He plans to try again with the current administration to audit their own PBM.

Modernizing PBMs and Ensuring Patient Focus

• 🎯 Tillis believes the mission of PBMs has varied dramatically since their inception, and it's crucial to determine if this "mission creep" is value-added or cost-adding.
• 🚀 The right-minded approach, he suggests, is to modernize PBMs, understand their value-add, implement price transparency, and ultimately create something with enduring value for the patient.
• 🤝 He advocates for getting all players into a "barbershop" for a comprehensive discussion on fixing the value chain, rather than using hearings to demonize specific links.

Fiduciary Duty and Transparency

• ❓ A question is raised about PBMs operating as fiduciaries, with the understanding that they recommend and administer benefits at the direction of employers, not making decisions for plan sponsors.
• 📊 Tillis notes that the industry has leaned in to embrace transparency and is willing to work with Congress to set a floor for transparency, allowing clients to choose additional data add-ons.