Keep promise on Medicaid pharmacy benefit managers
Three years ago, our leaders in Albany made a promise to the most vulnerable New Yorkers, those who participate in the Medicaid program: The state would transition to a new system for pharmacy services that would empower these patients to be able to choose their pharmacy and have access to the medicines that they need. The current system is controlled by pharmacy benefit managers — better known as PBMS — who dictate what pharmacies can serve these New Yorkers and what medicines are available — or, too often, not available.
This plan, included in the 2020-21 budget, represented a commitment to put patients first — particularly low-income urban and rural patients. It also represented a commitment to transparency, because PBMS have padded their pockets with profits that should have been shared with patients and the Medicaid program.
The grip that PBMS have on the current Medicaid pharmacy benefit program will not relent without a renewed commitment to the more than 7.6 million New Yorkers on Medicaid — and the political courage to stand up to the pharmaceutical benefit manipulation that has been the hallmark of pharmacy services in the New York Medicaid program for far too long.
Making this transition was, and continues to be, a smart fiscal policy for every New Yorker. In 2017, prior to our leaders in Albany agreeing to move to the new approach — called “fee for service” — New York Medicaid spent nearly $1.3 billion on generic drugs — more than all other state managed-care programs. And things have only gotten worse: While New York’s Medicaid members have waited for the promised transition to better pharmacy services, Medicaid costs have grown by double-digit figures, which is the fastest rate of increase since the Great Recession.
The same PBMS working to cut more holes in New York’s
safety net to stuff their already overflowing pockets routinely contribute to the higher price of drugs for New York patients and taxpayers. The Pharmacists Society of the State of New York found in its 2019 report that PBMS contracted by New York’s Medicaid program were routinely boosting prices for generic medicines. They reported that PBMS were marking up medications by 32 percent on average, which is nearly three times their markup in 2016. And it’s not just in New York: A recent U.S. Senate investigation exposed that PBMS play a critical role in keeping the price of insulin high across the country for similar reasons.
New York cannot continue to allow PBMS to siphon taxpayer funds and leave the residents who most need care without access to pharmacy services they deserve. In 2020, our leaders in Albany made a promise to New Yorkers in the Medicaid program that a transition to better pharmacy services lay ahead. It is time to fulfill that promise and stand up to PBMS and their perpetual manipulation of hard-earned taxpayer dollars.
Gov. Kathy Hochul and state legislators must resist further delay, stay on track, and finish the transition away from Pbmcontrolled pharmacy and toward a better future for all residents. New Yorkers’ care belongs to New Yorkers, and it’s time to put patients before PBMS.