Legislators and advocacy groups in Washington still have their sights set on PBM reform

Later this morning, Senate Finance Chair Ron Wyden (D-Oregon) and Ranking Member Mike Crapo (R-Idaho) are scheduled to hold a press conference to stress the need for Congressional approval of legislation to change how pharmacy benefit managers do business. 

As Axios is reporting, PBM reform has significant bipartisan support in both the House and Senate, but the industry’s lobbyists have been working behind the scenes for months to try to kill any reforms that might reduce profit margins. Wyden and Crapo are expected to make the case at the press conference and a Finance Committee hearing immediately afterward for including reforms in a funding bill that must be passed by the end of next week to avoid a partial government shutdown. 

Representatives of independent and chain pharmacies are expected to testify about how PBM business practices are jeopardizing their operations and harming patients. 

It’s likely that few Americans have even heard of PBMs, much less know how they control which medications we’ll have access to and how much we'll have to pay for them out of their own pockets, even if we have health insurance. Thankfully, the Center for American Progress has produced an excellent PBM explainer (you can view at this hyperlink or the button below.) Among other things, it shows how consolidated the PBM marketplace has become as big insurance corporations–like Cigna, where I used to work–have bought PBMs and turned them into money-making machines to pad their bottom lines.

In the next two weeks, our reporters will explain the dire straits many pharmacists now find themselves in and also what employers need to know and do now to avoid being taken to the cleaners by PBMs and their insurance company overlords. Congressional reforms are urgently needed, but employers–the biggest PBM customers–can take steps right away to save billions of dollars and dramatically reduce the amount of money their workers have to pay out-of-pocket for their medications.