Congress Has Just Weeks to Reform Runaway PBM Practices
By Greg Baker, CEO of AffirmedRx
As a pharmacist for over 30 years and now the CEO of a transparent pharmacy benefit manager (PBM), I’ve witnessed the devastating impact of our broken prescription drug system from every angle. Last May, I testified before Congress about the urgent need for PBM reform. Since then, my company has undergone a name change, inflation has continued to increase, our country has survived a pivotal election cycle, and yet Congress has still not moved to change the predatory PBM practices that are bankrupting Kentucky families and businesses.
With mere weeks left in this legislative session, Congress cannot wait until next year to act. The math is simple and shocking: In 2022 alone, Americans starting new therapies abandoned 94 million prescriptions at pharmacy counters because they couldn’t afford them. For every $1 increase in a drug’s list price, patients pay $2.09 more out of pocket – while PBM middlemen pocket increasingly larger rebates. When people can’t afford their medications, they get sicker, visit emergency rooms more often, and face preventable hospitalizations.
Three massive PBMs control 80% of the market, operating with virtually no transparency or oversight. They decide which medications your doctor can prescribe, what your insurance covers, where you can fill prescriptions, and how much you’ll pay. Often, they force patients to use their own mail-order pharmacies or “specialty” pharmacies, charging excessive prices while driving local pharmacies out of business.
The solutions are ready, proven, and completely doable. Congress must pass legislation requiring three critical reforms before the year’s end:
- Full transparency in all PBM pricing and rebate practices
- Delinking PBM compensation from drug prices to remove incentives for higher costs
- Mandatory sharing of negotiated savings directly with patients at the pharmacy counter
At AffirmedRx, based here in Louisville, we prove daily that transparent PBMs work. We show employers exactly where every dollar goes, pass through 100% of rebates, and let patients choose their own pharmacies. No hidden fees, no forced mail orders, and no games.
Yet at recent Congressional hearings, the big PBMs continued pushing false narratives about why they can’t operate transparently. Meanwhile, Kentucky small businesses struggle with soaring healthcare costs, seniors split pills to make prescriptions last longer, and local pharmacies close their doors. As a transparent PBM, we release all our data to our employers to demonstrate the value we provide them. If the traditional PBMs are saving their employers money, why don’t they release that information?
This isn’t just a broken system – it’s working exactly as the big PBMs designed it, maximizing their profits at everyone else’s expense. Each day Congress delays reform, PBMs extract millions more from Kentucky families and businesses through practices that would be illegal in other industries.
The bipartisan support for PBM reform is encouraging, but we’re running out of time. These reforms must pass before Congress adjourns for the year. Kentucky’s families and businesses can’t afford to wait while PBMs continue their price-gouging practices into another year, another Congress, or another election cycle.
As a pharmacist and a business leader, I know we can have a prescription drug system that works for everyone – patients, employers, and local pharmacies alike. The transparent PBM model proves it. Congress has the evidence and solutions before them. They must act right now to pass these critical reforms.
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Greg Baker is a pharmacist and CEO of AffirmedRx, a transparent pharmacy benefit manager based in Louisville, Kentucky.
