Autoimmune Association Backs PBM Reform Bill

The Autoimmune Association Applauds Senate Finance Committee Chairman Mike Crapo (R-ID) and Ranking Member Ron Wyden (D-OR) for introducing the Pharmacy Benefit Manager (PBM) Price Transparency and Accountability Act

The Autoimmune Association commends Senators Crapo and Wyden for reintroducing a bipartisan bill to increase transparency within the health care system and lower patient costs at the pharmacy counter. Pharmacy Benefit Managers (PBMs) currently operate under opaque conditions that enable them to drive up costs for patients in need, hurt independent pharmacies, and restrict access for autoimmune patients.

PBMs are corporations that administer drug prescription plans for insurance companies; they manage high-cost specialty medication. They help to control what medications are available, which can potentially restrict access for patients.

Patients living with autoimmune diseases and other chronic conditions face unique healthcare challenges. Their diseases require consistent treatment to manage their symptoms. Increased costs, limited formularies, and few pharmacy options all present significant access challenges to these patients who require specialized medications to manage symptoms and prevent flare-ups. We commend the bipartisan PBM reform bill before Congress for seeking to address PBM practices that allow them to profit at the expense of patients.

If passed into law, this legislation will be a significant victory for those living with autoimmune diseases who need accessible, affordable therapies and medications to combat their illnesses.

Read More about PBMs:

Autoimmune Association Advocates for Federal Legislation to Reform Harmful PBM Practices

Wyden, Crapo Introduce Bipartisan Pharmacy Benefit Manager Legislation

Key Terms:

• Drug Formulary — A list of prescription medications covered by a prescription drug plan or another insurance plan offering prescription drug benefits.
• Formulary Tiering — Used by Pharmacy Benefit Managers (PBMs)/health insurance plans to categorize prescription medications into different tiers generally based on their cost and clinical effectiveness. Typically, medications in lower tiers have lower copayments or coinsurance for patients, while those in higher tiers require higher out-of-pocket costs. Tiering may also be based on factors some with perverse incentives.
• Pharmacy Benefit Managers — Corporations that administer drug prescription plans for insurance companies; they manage high-cost specialty medication. They help to control what medications are available, which can potentially restrict access for patients.