Our partners at AffirmedRx, a Public Benefit Corporation were featured in an article published by the House Oversight Committee in advance of their hearing with representatives from the “big three” in the pharmacy industry. This article highlights the challenges posed by the current traditional practices of the “big three”, and also underscores the importance of transparency and fairness in the pharmacy industry. AffirmedRx is the only transparent PBM mentioned by name in this report. We are so proud of our partnership with them, making sure our members work with People You Trust.

The recognition is a testament to AffirmedRx’s commitment to operating with integrity and always putting patients first. Greg Baker, CEO, has met with numerous lawmakers in Washington, D.C., aiming to influence PBM reform. The article and the upcoming hearing are pivotal moments in the ongoing efforts to bring about necessary reforms in the PBM sector.

Here are some key takeaways from the article:

1. Anti-Competitive Practices:
   • The report details how the largest PBMs leverage their market dominance to enforce policies that stifle competition. This includes steering patients towards pharmacies they own, thereby limiting patient choice and increasing overall healthcare costs.
2. Impact on Drug Costs:
   • It was revealed that the practices of these PBMs have significantly driven up the cost of prescription drugs. This is largely due to opaque pricing mechanisms, such as spread pricing, where PBMs charge payers more than they reimburse pharmacies and pocket the difference.
3. Patient Care:
   • The report highlights the detrimental effects on patient care, including delayed access to essential medications due to prior authorization requirements and formulary restrictions. These practices not only compromise patient health but also lead to increased out-of-pocket expenses.
4. Lack of Transparency:
   • One of the core issues identified is the lack of transparency in PBM operations. The report calls for increased transparency to ensure that savings from negotiated discounts and rebates are passed on to patients and payers, rather than being retained as profit by PBMs.
5. Regulatory and Legislative Recommendations:
   • The article discusses the need for federal and state-level reforms to address these issues. Recommendations include banning anti-competitive practices, ensuring fair reimbursement for pharmacies, and mandating transparent reporting of all fees and rebates.

Read the full article below or by clicking HERE.

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