I am Executive Director of Health Care that has struggled with medication. Then my daughter’s condition made a personal
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Why is it so hard to get Medicines your doctor prescribes?? Why do patients and families spend countless hours fighting for standard care treatments? Why are potentially rescue remedies delay for weeks or months?
That these issues are too often asking can be to blame for one of the least understood Healthcare problems today: Role of pharmacy manager (PBMS). These powerful intermediaries – not your doctor – are increasingly deciding which medicines you get, how much you pay them and where you get them.
My role of executive director of the Pontchartrain Cancer Center gave me a place for the systemic dysfunction of PBM.
PBM are originally created to lower the cost of medication and simplify access to medication. (East)
My 19-year-old daughter recently faced a health condition that required the treatment of a standard care prescribed by her doctor. Even with her professional expert, her doctor and I spent countless hours struggling with PBM to approve medication. He was finally approved in February, but it still took 10 long weeks before she could access.
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Each step of the way we came across a system where no one wanted to take responsibility; One person after the other has a problem like a hot potato game. The psychological tribute of this temptation – on it, on our family and in her medical team – is out of words. If, with all the resources and knowledge, I can’t go through this bureaucracy, what kind of hope does any other American have?
Unfortunately, this is not an isolated incident. Millions of patients across the country face similar barriers: forced to withstand deprived, delays, and care disorders due to increase PBM Straglehold on Medicine.
These are not just administrative inconvenience; They are a life of dangerous obstacles. Patients suffering from cancer, chronic conditions or rare diseases are caught in a system that seems to price a corporate profit of PBM with respect to human life.
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PBM are originally created to lower the cost of medication and simplify access to medication. Over time, however, they turned into entities that manipulate the system to maximize the profit of patients.
The deterioration of things is a vertical integration that has enabled PBMS to dominate every aspect of a prescription drug supply chain. Today, the largest PBMS – Caremark RX, LLC (CVS), Express Scripts, Inc. (ESI) and Indjemrx, Inc. (Indjerex) – not only managing the benefits of medication. They also They own pharmacies who fill in recipes and insurers who pay them.
This means that they have a financial incentive to prioritize their own profit at every turn: they manage patients with their own pharmacies, limiting access to competitive drugs and increase costs from their pocket. With almost 80 percent of prescription drugs that only these three PBM controls, their decisions form health experiences of almost every American. This vertical integration consolidates strength in ways that simply harm patients.
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The Federal Commission for Trade (FTC) recently exposed that a large three PBM has set up a chain of medication supply to inflate the costs and submit their earnings. FTC -ovi the latest reportPublished in January 2025, he pointed out that PBMS adds significant markings to special generics, inflatable costs for cancer, HIV and other life -saving drugs.
Even in a federal investigation, the FTC report shows that these intermediaries generated $ 7.3 billion in revenue from 2017 to 2022 by managing patients towards their own pharmacies, compensating for higher rates from independent competitors and involving predatory practices such as pricing.
Yet, despite the increasing evidence and two -sided calls for reforms, Congress failed to act At the end of 2024. This missed opportunity is more than disappointing – it is dangerous. Patients cannot wait while legislators play politics.
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Congress must immediately take measures to adopt a meaningful PBM reform. Home energy and health trade recently held a hearing to discuss the inflation of prices aimed at PBM, obstacles to care and consolidation on the market. The testimony has strengthened what patients and healthcare professionals already know: PBM -do they increase the costs and limit access, without lowering them.
These reforms have wide two -sided support and represent real solutions. Patients deserve more than unclear obligations; They deserve action.
President Donald Trump Eliminating waste, fraud and abuse in the Government is a cornerstone from the agenda of its administration. The PBM reform is clearly extension of these missions of the mediators used to inefficiency for too long, and it is time to restore the transparency, honesty and policy of the first patient to the system.
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Congress must undergo a significant PBM reform – not tomorrow today. For my daughter and for the myriad of patients I have struggled for over the years, this is not an abstract discussion of politics. It’s real, it’s urgent and it’s deep personal.
It’s time to put patients before profit and politics. Congress missed a key opportunity in 2024. Let’s make 2025 in the year in the year to finally stop these life-threatening PBMs and bring humanity back to health. For my daughter and for our loved ones, we cannot afford to wait more.
