Dear Chairman Wyden, Ranking Member Crapo:
The undersigned patient groups, representing millions of patients across the United States living with cancer, cystic fibrosis, epilepsy, and multiple sclerosis write to thank you for the continued work of the Committee to reform pharmacy benefit manager (PBM) practices that result in higher out-of-pocket costs for patients.
We are particularly supportive of the “de-linking” provision included in the Modernizing and Ensuring PBM Accountability (MEPA) Act that would prohibit PBMs from being compensated for Medicare Part D covered drugs based on the manufacturer’s list price, as is common practice. MEPA would instead require that PBM compensation be in the form of a bona fide service fee that reflects a fair market value based on an audit from the U.S. Health and Human Services’ Office of the Inspector General.
Our organizations regularly hear from people with both acute and chronic conditions about the many challenges they face accessing life-changing or life-saving medications across the drug supply chain. We agree with many of the sentiments expressed in the July mark-up highlighting concerns that the current practices that enable PBMS to prioritize more expensive drugs because they often receive a higher rebate or payout for those therapies. This reimbursement structure disincentivizes the use of lower cost biosimilars or generic medications.
The de-linking provision, along with others included in MEPA, will bring much needed reforms to these areas to help people access and afford the medications they need to treat and manage their conditions. Our organizations believe this measure will make a significant difference for Medicare beneficiaries’ out-of-pocket costs and support efforts to increase transparency and enable patient access to necessary therapies.
We applaud the work the Finance Committee has done to date on PBM reform; however, we urge you to work with your colleagues on the Health, Education, Labor and Pension’s Committee as well as the House Energy and Commerce and Ways and Means Committees to expand the de-linking provision to the commercial market to align incentives across the entirety of the U.S. healthcare system.
Our organizations, representing millions of people who live with acute and chronic diseases, urge the Senate to act this fall and pass comprehensive and common sense PBM reform to improve patient access to and affordability of the medications they need to live their lives. Please utilize our groups as resources during this process.