Threatening patient health

Congress must reform insurer, pharmacy benefit manager practices

THE lengths that insurance companies and their so-called pharmacy benefit managers force patients to go to access the life-sustaining and lifesaving medications and treatments they need have gotten out of control. It is far past time for our leaders in Washington to stand up to insurers, PBMS and the harmful policies and practices they use to control patient access and the entire prescription drug marketplace.

Given how many people this issue affects in Nevada and across the country, it’s deeply upsetting and disappointing that Congress hasn’t yet passed PBM reform. What makes it worse is that there seemed to be some real, bipartisan momentum behind PBM reform last year, with various pieces of legislation drafted and introduced by lawmakers on both sides of the aisle. Lawmakers need to get it together and make PBM reform the priority it deserves to be in Congress.

As someone who lives with type 2 diabetes, my experience with insurance and PBM policies has been far from pleasant. My PBM keeps changing brands of insulin on me, forcing me to make new doctor appointments in order to get new prescriptions. I also have to purchase new needles with every new brand. If this were a one-time thing, I’d understand — but it’s happened several times now, with no explanation as to why.

My job building and maintaining cell towers keeps me busy, often requiring me to work long hours and take day jobs in other states. I do not have the time or money to keep making extra appointments that aren’t necessary for my health and are necessary only because of the insurance and PBM bureaucracy that patients must navigate to get their doctor-prescribed medications.

But that’s just the tip of the iceberg when it comes to harmful PBM practices. To keep their costs low and profits high, PBMS also use harmful prior authorization and patient steering policies that can restrict patient access, lead to unnecessary delays in care that can worsen patients’ health or even deny patients the critical care and treatments they need.

As health care middlemen, PBMS will also often secure vital prescription rebates and discounts directly from drug manufacturers. Theoretically, PBMS could pass those down to patients to reduce burdensome out-of-pocket costs that make it harder for millions of Americans to afford the medications they need. However, that is just in theory, as PBMS are notorious for simply withholding and absorbing these savings in order to inflate their profit margins even further.

We have waited long enough for a solution. Lawmakers in Congress must hold PBMS more accountable for their practices that threaten patients such as me here in Nevada and nationwide. The fastest and best way they can do that now is by working to pass meaningful legislation, such as the Delinking Revenue from Unfair Gouging (DRUG) Act.

Reforming PBMS to improve patient access and lower out-of-pocket costs is a huge issue for tens of millions of patients across the country — patients who are also voters. With the 2024 elections quickly approaching, lawmakers would be smart to notch a win for patients by passing PBM reform as soon as possible. Nevada’s lawmakers should work to make that happen.

As someone who lives with type 2 diabetes, my experience with insurance and PBM policies has been far from pleasant.

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