Swift testifies at hearing to rein in health care spending
One lawmaker accused pharmacy benefit managers of making “disingenuous” arguments about soaring medication costs. Another described the industry middlemen as “taking a moblike approach.” And a former governor recalled being driven to her “boiling point” because of the struggles her daughter had accessing a vital prescription drug.
Pharmacy benefit managers, which negotiate between health insurers, manufacturers, and pharmacies, landed in the hot seat Tuesday as lawmakers ponder how to rein in health care spending following years of disagreement among House and Senate Democrats.
Both chairs of the Legislature’s Health Care Financing Committee lambasted a representative of the pharmacy benefit manager industry, who came to the panel’s hearing to defend PBMs and argue that they are not responsible for rising costs often passed along to patients.
“No one is required to use a PBM. Plans choose to do so because PBMs save on prescription drug costs,” Sam Hallemeier, director of state affairs for the Pharmaceutical Care Management Association, told the committee. “PBMs are the only entity in the drug supply chain that exists to increase competition and drive down costs. We’re concerned that attempts to remove PBM tools will increase costs, lower competition and, at times, add no value to patient care or outcomes.”
The legislative barbs came out quickly.
“I just wish you all would come to the table in a meaningful and honest way, and what is so disturbing to us is that we can’t have conversations with you where you’re honest about what you’re doing,” co-chair Senator Cindy Friedman replied when Hallemeier completed his prepared remarks. “That is why we are so hellbent on trying to solve this problem, because people are suffering, they’re dying, they can’t afford it. And to point fingers at everybody else, it’s disingenuous, and it’s not useful.”
Fellow co-chair Representative John Lawn jumped in, saying that the companies “are really taking almost a mob-like approach to this.”
“There’s a lot of players in here that are making money, but we have an obligation to try to have drugs that are available to the citizens of Massachusetts that are affordable,” Lawn said.
Lawn filed legislation that would require PBMs to be licensed, offer patients a “reasonable” network to access prescription drugs, and avoid the use of “spread pricing,” when they pay a pharmacy less than they bill a payer and pocket the difference.
Other bills on the committee’s agenda, including the latest version of a Friedman prescription drug pricing control bill the Senate has approved in two straight sessions, also seek reforms to PBMs.
The growing campaign to subject PBMs to new scrutiny and regulations gained a new ally Tuesday: former governor Jane Swift.
Testifying about legislation at a committee hearing for the first time in two decades, Swift told lawmakers about years of struggles that she and her daughter, Lauren Hunt, have endured to secure medication for Hunt’s juvenile arthritis.
Hunt said the medication she needs is only available from specialty pharmacies that contract with pharmacy benefit managers, so she cannot pay out-ofpocket to get it elsewhere in a pinch. That means that when the medication suddenly becomes unavailable or fails to be delivered by mail, she goes weeks without taking her regular dosage, suffering debilitating and unnecessary pain.
This winter, Hunt recalled, a PBM failed to fill her prescription “with one lame excuse after another.” After hours of frustrating phone calls that Swift said pushed her to her “boiling point,” they learned that the medication shipment had been delayed because of computer errors impacting the PBM’s communication with Blue Cross Blue Shield of Illinois.
Yet the pharmacy benefit manager had “no obligation” to inform Hunt or other patients, she said.
“I have the best rheumatologist in the country. I now pay for not only one, but two great insurance plans. I have a mother who is the former governor of Massachusetts. I have a degree from a prestigious US university. Yet my access to the medications I need to live not only a healthy lifestyle, but one where I can simply get out of bed in the morning, is non-existent,” Hunt, 22, told the committee.
Swift contrasted the lack of consumer protections she and Hunt faced with the widespread coverage of Southwest Airlines’ service meltdown this winter.
“If your flight is canceled, that has to be reported to the federal government,” Swift said. “If your meds that you need, lifesaving meds, aren’t mailed to you, no one has to be told and the problems don’t have to be reported. That is just not right.”