A CVS store. (Photo by Lynne Terry, Oregon Capital Chronicle/States Newsroom.)
By Jennifer Riley
A new Federal Trade Commission’s report sheds light on a disturbing trend in the prescription drug market. Pharmacy benefit managers (PBMs) are charging enormous markups on life-saving specialty generic drugs, including those used to treat cancer, HIV, and other critical conditions. A disproportionate share of these specialty generic drugs is marked up more than $1,000 per prescription.
The report shows that PBMs made over $7.3 billion in extra profits from dispensing specialty generic drugs during the study period. These PBM middlemen, who should be lowering costs, are instead contributing to the financial burden on patients who rely on these vital medications.
For patients in Pennsylvania, these practices hit especially close to home. With 7.7 million Pennsylvanians and counting having at least one chronic disease and a growing population of individuals requiring specialty medications, our families are among those most affected by these inflated drug costs. Many patients in our state are forced to make impossible choices between affording medication and meeting other basic needs.
Last year, Pennsylvania lawmakers from both parties, along with Gov. Josh Shapiro, came together to pass comprehensive legislation aimed at regulating PBMs. However, it is widely accepted that federal law preempts state law in regulating pharmacy benefit managers. This, coupled with the new FTC investigation, is a stark reminder that there is still work to be done to hold PBMs accountable.
With the use of specialty medications expected to increase 3-5% per year over the next decade, we need to protect and ensure fair pricing for the millions of Americans—and Pennsylvanians—who depend on these drugs to survive.
Jennifer Riley is the executive director of the advocacy organization Patients Come First PA. She writes from Malvern.