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Blame The Game Or The Players?
As we enter a new year and Congress assumes office, the debate surrounding pharmacy benefit managers (PBMs) has reached a boiling point. It is crucial for policymakers to focus on addressing the root causes of the issue rather than applying Band-Aid solutions that might inadvertently worsen the problem.
Pharmacy benefit managers have been under scrutiny due to their role in controlling prescription drug benefits and managing Medicare Part D premiums, which were only 0.7% annually from 2010 to 2023 – a remarkable feat. However, concerns arise as they also manipulate the placement of branded drugs on formularies, thereby affecting manufacturers’ revenue, and influence reimbursement amounts for pharmacies.
It is essential to acknowledge that every player in the drug supply chain seeks financial gains. Proponents of stricter regulations might argue that weakening PBMs would benefit patients by reducing costs. However, there is no concrete evidence to support this notion, except in scenarios where insurance and PBMs are bypassed entirely for specific drug transactions.
The primary issue lies not with the players but rather with the game they operate within. The safe harbor protections, which exempt drug rebates from federal anti-kickback statutes, foster rebate retention by PBMs. This practice contributes to higher list prices and patient cost-sharing, ultimately affecting health outcomes. To effectively address this issue, policymakers must focus on removing bad rules that perpetuate these negative consequences.
Rather than blaming the players, we should recognize that questionable behaviors in the healthcare sector are often driven by flawed policies with unintended consequences. Our new administration has an opportunity to re-examine existing regulations and create a more favorable environment for better health outcomes.
In conclusion, it is crucial for lawmakers to focus on modifying the game rather than attacking the players. By addressing the root causes of these issues, we can work towards a more efficient and patient-centric healthcare system.
Source: http://www.forbes.com
