Industry Lobby's Response to Growing Congressional Pressure on PBMs: Q&A

At a recent conference hosted by Abarca Health, a pharmacy benefit manager, in San Juan, Puerto Rico, MedCity News' Editor-in-Chief Arundhati Parmar and Senior Reporter Katie Adams had the opportunity to attend and speak.

The conference delved into the future of healthcare and pharmacy benefit management. Here is a recap of an interview with JC Scott, president and CEO of the Pharmaceutical Care Management Association (PCMA).

The pharmacy benefit management industry is currently under scrutiny, with big players like CVS Health's CVS Caremark, Cigna's Express Scripts, and UnitedHealthcare's Optum facing accusations of anti-competitive practices that drive up the cost of prescription drugs.

This issue has led to legislative actions at both the state and federal levels, with a recent Senate Commerce Committee hearing on the proposed Pharmacy Benefit Manager Transparency Act.

During the Abarca Forward conference, Scott discussed the ongoing legal battle with Oklahoma over its Patient's Right to Pharmacy Choice Act, which PCMA believes violates federal law. The court is currently seeking input from the US government on the matter, with the case now in the hands of the 10th Circuit Court of Appeals.

Scott emphasized the importance of provider networks in maintaining uniformity across benefit and plan designs, highlighting the benefits of using in-network pharmacies for both plan sponsors and patients. He also addressed the issue of competition and the need for robust market dynamics to drive down drug prices and make medications more affordable.

While legislative action is expected in the coming year, the political landscape may pose challenges to passing comprehensive healthcare legislation.

Scott underscored the importance of holistic solutions that involve every aspect of the healthcare supply chain, rather than point fingers at individual industry players.

Ultimately, Scott stressed the need for increased competition in the marketplace to address the underlying cost of drugs and improve patient access to affordable medications. By fostering a competitive environment and preventing anti-competitive practices, the industry can work towards lowering prescription drug costs and improving overall healthcare outcomes.