I agree with the opening line of Tabitha Mueller’s Indy Explains: Are pharmacy benefit managers to blame for high drug prices – Nevadans do pay too much for prescription drugs. But I whole-heartedly disagree with Jared Whitley’s pro-pharmacy benefit manager (PBM) opinion piece. I haven’t experienced the health care system he outlined in my daily life.
The world of health care can often be convoluted, leaving patients with more questions than answers. Despite the evidence stacked against PBMs for years, there has been an unacceptable lack of action, forcing patients to fend for themselves. That’s why patients such as me are counting on our political leaders to enact PBM reform.
I was diagnosed with SLE (systemic lupus erythematosus) at the age of 19. Fast forward 23 years —I’ve had to leave my career as an educator and my bank account is consistently overdrawn. Even though I no longer have the strength to teach in a classroom, I will always be an educator — and more importantly, a student. Though not a chosen subject of study, my illness forced me to do my homework on PBMs.
The Federal Trade Commission (FTC) and the U.S. House Oversight and Accountability Committee has found that just a few PBMs control nearly the entire prescription drug marketplace, filling more than 95 percent of prescriptions in the United States. Since these companies control such large market share, and are often integrated within insurers and chain pharmacies, they can steer patients toward pricier treatments, even if lower-cost options may be just as effective.
Since I was diagnosed, I have been prescribed an array of medication. Unfortunately, these middlemen have interfered with the decisions made by my doctor. Throughout my health care journey, I have been forced to take medications that were less effective than the treatment my doctor initially prescribed. Sadly, it seems that the only reason for this was to boost PBM profits. Insurance companies should not get between a patient and their doctor. Yet, oftentimes, the middleman gets in the way.
The FTC also found that PBMs not only steer patients toward certain medications, but also toward certain pharmacies, reimbursing their own pharmacies at higher amounts than unaffiliated competitors. Despite receiving sometimes hefty rebates from drug manufacturers, PBMs have found loopholes to retain large portions of the savings.
As anyone who has picked up medication at the pharmacy knows, any amount of savings can make a huge difference. It’s time our lawmakers ensure that we receive the full savings we deserve.
While some states have enacted Share the Savings with Seniors legislation, Nevada has fallen behind, and I believe our leaders in Washington should push for federal legislation that ensures PBMs pass down the discounts and rebates they receive from drug manufacturers in full. Doing so could be a lifeline for patients in our state and across the country, potentially lowering our out-of-pocket costs and improving our access to the prescription medications we rely on.
Most physicians, providers and policymakers have no idea what it feels like to live daily with a body that fails you. I had to give up the work I was educated and trained for — and loved to do. I make a choice, daily, to put on a brave face and carry on, even if it means spending days in bed recovering. Elected officials can’t blame the dog for eating their homework — it’s time they make a choice and bravely stand up to PBMs.
Kjerstin West is a North Las Vegas resident on private insurance.
The Nevada Independent welcomes informed, cogent rebuttals to opinion pieces such as this. Send them to [email protected].
