The federal government overspent $321.3 million of our tax dollars on prescription drugs for the Federal Employees’ Compensation Act (FECA) program over six years due to the absence of pharmacy benefit managers, according to a new report from the Department of Labor (DOL) Office of Inspector General (OIG). This striking new data underscores how PBMs are an effective private sector mechanism that drives down healthcare costs.
Unfortunately, Sen. Bernie Sanders (I-VT) is working to have the government interfere in the success of PBMs through his Pharmacy Benefit Manager Reform Act. As he has long sought, this bill would be a step towards government-run healthcare, resulting in higher prices and worse patient outcomes.
PBMs have administered drug plans for over 275 million Americans, generating substantial benefits and savings. By negotiating on behalf of large groups like employers, PBMs secure significant discounts from pharmaceutical companies based on economies of scale. These savings are then passed onto health plan sponsors and patients, amounting to an average annual savings of $1,040 for patients. Utilizing tools such as formularies and drug utilization reviews further enhances PBMs’ cost-saving abilities, resulting in improved medication adherence and prevention of fraud. This capability averts costly and potentially lethal consequences, as highlighted in the DOL IG report , where lacking a PBM led to inappropriate prescriptions and dangerous drugs for FECA claimants.
Reports (and history) have consistently proven the effectiveness of PBMs in lowering drug costs and improving healthcare outcomes. The expansion of PBMs in the 1980s played a pivotal role in negotiating lower drug prices with manufacturers and pharmacies, benefiting employers and consumers alike. Furthermore, the Government Accountability Office’s 2019 report on Medicare Part D showcased how PBMs, through their negotiated rebates and price concessions, significantly lowered healthcare expenses, ultimately benefiting Medicare patients.
Despite the overwhelming evidence of PBMs’ value, some members of Congress are advocating for more government red tape and interference in the healthcare marketplace, which risks jeopardizing PBMs’ negotiating power. Bills like the PBM Reform Act empower government bureaucrats to dictate healthcare prices, risking a shift towards government-run healthcare that could harm the patients they aim to assist.
The dire financial and personal consequences highlighted in the DOL IG report should serve as a wakeup call to policymakers. Instead of interfering with the successes of private healthcare, Congress should heed the lessons from these reports and historical data by embracing the expansion of PBMs to foster competition and innovation in the industry. PBMs have consistently proven their ability to reduce drug costs and improve healthcare quality, benefiting all Americans. The best approach to healthcare cost management lies in leveraging the negotiating power and expertise of PBMs, not in introducing unnecessary government intervention.
The PBM Reform Act is not the solution to healthcare cost management. This bill would have the opposite impact of its stated goals of reducing drug prices. Instead, Congress should embrace the facts and support the expansion of PBMs to create an environment that fosters competition, innovation, and improved healthcare quality for all Americans. Health care costs are skyrocketing and this is the opportunity to unleash the power of PBMs and revolutionize our inefficient healthcare system for the better.