Sen. Marshall, keep working to make health care affordable for Kansas and the US | Opinion

Pharmacy benefit managers or PBMs play a critical role in our health care system, acting as intermediaries between insurers, pharmacies and drug manufacturers. However, over time, the practices of the largest PBMs have strayed from their intended purpose, often resulting in higher costs and reduced access to necessary medications for patients as they manipulate the system to their favor.

This year, Kansas Sen. Roger Marshall has taken a bold stand to address these issues, championing bipartisan reforms that seek to restore fairness and transparency to this complex system. For this, he deserves our deepest thanks — and our encouragement to continue pushing for meaningful change.

As the ranking member of the Senate Health, Education, Labor, and Pensions Committee’s Subcommittee on Primary Care and Retirement Security, Sen. Marshall has played a pivotal role in advancing the bipartisan Pharmacy Benefit Manager Reform Act, S. 1339. This legislation is a critical step toward ensuring that employers have the transparency they need to make informed decisions, ultimately leading to lower costs for their employees and families. By introducing this bill in collaboration with committee leaders, Marshall has demonstrated his commitment to bipartisan solutions that put the needs of American workers and their families first.

But Marshall’s efforts don’t stop there. His leadership was also instrumental in the Finance Committee’s advancement of the Modernizing and Ensuring PBM Accountability Act. This legislation, which includes two of Marshall’s bills, directly targets the abuses of industry middlemen within Medicare and Medicaid. These bills aim to curb the practices that allow PBMs to manipulate the system at the expense of taxpayers and beneficiaries, ensuring that public programs work for the people they’re meant to serve.

The importance of these reforms cannot be overstated. The three largest PBMs have consolidated power over the years, using their position as middlemen to implement anticompetitive policies that protect their bottom line at the expense of patients. By integrating with health insurers, pharmacies, providers and even drug manufacturers, these PBMs have created a system where they can dictate terms that often lead to higher costs and fewer choices for patients. It’s a scenario that benefits no one except the PBMs themselves.

PBMs often argue that their negotiation tactics, drug utilization programs, and spread pricing mechanisms result in savings for payers and patients. Spread pricing happens when PBMs charge insurers, employers, government health programs, and health plans more for drugs than the amount they reimburse the pharmacy for the medication. The PBM then proceeds to pocket the difference.

However, mounting evidence suggests this system doesn’t result in savings for payers and patients. These schemes often lead to increased costs, as the savings are not passed on to the consumer but are instead absorbed by the PBMs. Patients and payers alike are left footing the bill, with little to no recourse.

Moreover, the tactics employed by the largest PBMs have a direct and detrimental impact on the health outcomes of millions of Americans. The use of prior authorizations, fail-first policies and formulary manipulations often results in delayed or denied access to necessary medications. For patients with chronic or life-threatening conditions, these delays can be devastating, leading to worsened health outcomes and, in some cases, irreversible damage.

Marshall’s efforts to address these issues are commendable, but the work is far from over. The fight for PBM reform is a fight for the health and well-being of every American. It’s a fight to ensure that our health care system is fair, transparent, and, most important, centered on the needs of patients, not the profits of industry middlemen.

It is critical that Marshall continues to champion these reforms. His leadership is needed now more than ever to push forward legislation that holds PBMs accountable and ensures that the health care system works for all Americans. The bipartisan support for PBM reform is a testament to the widespread recognition of the problem, but it will take continued effort and determination to see these reforms through this year.

In thanking Marshall for his work, we also encourage him to stay the course. We hope that he’ll continue to lead on patient-centric issues as we move into the final months of this legislative session. The road to meaningful pharmacy benefit manager reform is long and challenging, but with leaders like Sen. Marshall at the helm, positive and meaningful change is within reach.