ICYMI: This opinion piece appeared in the South Florida Sun Sentinel on Jan. 7, 2024
By Robert Levin
I read with great concern Nicole Natale’s recent op-ed expressing worry over the proposed regulation of pharmacy benefit managers (PBMs) in Florida. As a practicing rheumatologist deeply involved in patient care, I feel compelled to offer an accurate perspective, challenging the opinion Natale presented.
The leap taken by Natale to argue against regulating PBMs ignores key facts. PBMs are companies hired by insurers to manage drug benefit programs. They essentially act as middlemen between insurers, manufacturers and pharmacies and thus have a uniquely central role in the drug market, handling everything from setting patient copayment amounts to determining which drugs are covered by which health plans. Their involvement in the health care landscape has broad implications, and blaming the escalating costs of life-saving medications solely on the pharmaceutical industry’s pricing strategies oversimplifies a complex issue.
I acknowledge that PBMs, as intermediaries negotiating drug prices, play a role in determining how much patients pay for their prescriptions. Natale asserts that only 6% of every dollar spent on prescriptions goes to PBMs, while 65% goes to drug companies. However, these percentages don’t necessarily reflect the actual impact on patients’ out-of-pocket expenses. The opaque practices of PBMs often result in higher costs for patients at the pharmacy counter.
Moreover, the argument that PBMs have been a lifeline for Florida’s seniors is not without its flaws. While Natale cites the Office of Management and Budget’s findings of a 20% savings in Medicare Part D, it’s essential to scrutinize the entire cost structure. We must consider whether these savings translate into tangible benefits for patients, especially when PBMs may play a role in determining which drugs are covered or placing restrictions on access.
The proposed PBM Transparency Act, which Natale criticizes, aims to shed light on the practices of these intermediaries. Transparency is a cornerstone of accountability, and understanding how PBMs operate is crucial to ensuring that their actions genuinely benefit patients. Instead of dismissing these efforts outright, we should encourage transparency measures that safeguard the interests of patients and foster a fair and competitive pharmaceutical market.
Natale’s emphasis on the potential negative consequences of regulating PBMs for small businesses is a valid concern. However, we must weigh these potential disruptions against the long-term benefits of fostering a health care system that prioritizes affordability and patient well-being over the interests of intermediaries.
As physicians advocating for the well-being of our patients, we should not shy away from scrutinizing the practices of all stakeholders in the health care industry. Rather than absolving PBMs of accountability, let us encourage open dialogue and comprehensive reforms that address the root causes of soaring drug prices. By doing so, we can work toward a health care ecosystem that truly prioritizes accessible and affordable care for all Floridians.
Dr. Robert Levin, a Clearwater-based rheumatologist, is president of the Alliance for Transparent and Affordable Prescriptions.