Prescription drug prices have long been the bane of patients, doctors, politicians and the American public at-large.
Now, U.S. Rep. Jake Auchincloss, D-Newton, has teamed up with Republican Congresswoman Diana Harshbarger of Tennessee—a former pharmacist—to craft the Pharmacists Fight Back Act to rein in abusive practices by benefit managers working for health insurance companies.
“They’re all Fortune 20 companies, and they’ve captured about $300 billion from the U.S. health care system with the claim that they negotiate drug prices on behalf of employers and patients,” Auchincloss said. “And it turns out that they don’t. They are price-gouging pharmacists and self-dealing to improve their bottom lines and to serve their insurance overlords.”
By “self-dealing,” Auchincloss refers to a practice known as “steering.” That’s when an insurance company requires the drugs with the biggest profit margin only be dispensed by that company’s affiliated pharmacies.
“CVS Caremark will do this, Cigna Express Script, United Health Group—the big three—they all do this,” Auchincloss said. “That’s only one of their many abuses.”
Another example is the designation of “specialty products,” which Auchincloss said is a business term, not a medical term, referring to drugs that companies can hike the price of because the customer has no choice but to take that medication.
The Pharmacists Fight Back Act is a reform bill for federal health care programs (Medicare Part D, Medicare Advantage, Medicaid managed care, Tricare and the Federal Employees Health Benefits Program) that, if enacted, would:
- prohibit large pharmacy benefits managers from manipulating drug prices and restricting network access and patient choice in federal healthcare plans.
- implement a transparent pharmacy reimbursement model using market-based pricing benchmarked to the national average drug acquisition cost and capping drug costs to no more than NADAC plus a fair dispensing fee plus 2 percent.
- prohibit benefit managers from restricting patient choice via network exclusions and from steering patients to affiliated pharmacies.
- require that pharmacy benefit managers share 80 percent of rebates with patients at the counter while preserving 20 percent of rebate dollars for the purposes of suppressing premium growth.
- prohibit point-of-sale fees and retroactive fees, brand mandates, spread pricing and more.
“We’ve uncovered markups for multiple sclerosis drugs of about 10,000 percent, leukemia drugs about 5,000 percent,” Auchincloss said. “And these are insurance companies, mind you. This isn’t like when a pharmaceutical company invests in the R&D and has to get a return on it. This is pure price-gouging.”
You can read the full text of the Pharmacists Fight Back Act here.