PBM policies threaten patients with disabilities

Today is the final day of National Development Disabilities Awareness Month. As someone living with ADHD, it’s an important time for me to share my story and struggles to help shine some light on a condition that affects millions of Americans, including adults. While some of those struggles are specific to living with attention-deficit/hyperactivity disorder, others are shared with patients facing myriad conditions, disorders or diseases who rely on taking prescription medications daily.

I find it is often hard to be taken seriously as an adult living with ADHD who needs to take prescription medications regularly just to be able to succeed, whether at work or in an educational setting. Missing just a few doses of the prescriptions I take can have a detrimental impact on my ability to focus on and complete daily tasks at work and in my personal life.

As tens of millions of Americans can attest, it is a strange feeling to be so reliant on access to prescription drugs. It is also scary knowing how little control patients have over their own access to the doctor-prescribed medications they need to live healthier, more normal lives. That is especially true when pharmacy benefit managers (PBMS) get involved and enforce their unfair, profit-driven policies that undermine access and inflate out-ofpocket expenses for patients.

PBM policies like step therapy and prior authorization only exist to cut costs for PBMS by restricting, delaying and even denying access to vital prescription drugs, therapies and treatments for patients. Both of these arcane policies create unnecessary barriers to care that patients must navigate, which can often result in patients going without the medications they need.

For me and others with ADHD, these delays or interruptions in access can be a difficult burden, making it harder to do the things we all have to do in our everyday lives. However, for patients with more life-threatening illnesses or diseases, these access issues can worsen health care outcomes and lead to disease progression. PBM policies that threaten patient access can put people’s lives in danger.

The broken, self-serving policies PBMS use also lead to higher out-of-pocket expenses at the pharmacy that can put many medications just out of reach for the vulnerable patients who need them. In some cases, these policies link the fees PBMS receive to the list price of prescription medications, which encourages PBMS to only cover higher-cost drugs. As a result, patients are forced to pay for more expensive treatments when lower-cost alternatives could work just as well.

In other cases, PBMS will just hoard the discounts and rebates that they secure from drug manufacturers instead of passing those down to patients to help them reduce their high out-of-pocket expenses. Either way, PBM profits continue to soar while patient access is thrown by the wayside.

The most frustrating part of all of this is that lawmakers in Congress had a golden opportunity to pass bipartisan PBM reform legislation last year. Momentum to harness PBMS’ harmful impacts seemed to be growing on both sides of the aisle, and multiple pieces of legislation were introduced and discussed in various committees. However, Congress ultimately dropped the ball once again and failed to pass any meaningful reform in 2023.

As National Development Disabilities Awareness Month comes to a close, Nevada’s congressional leaders should work together to pass much-needed and long-overdue PBM reform. Hopefully, Nevada’s senators and representatives can help make that happen, so patients in Nevada and nationwide can have one less thing to worry about.