BioUtah and Coalition of Patient Advocates Talk PBM Reform with U.S. Reps. Blake Moore and Celeste Maloy

October 3, 2024

BioUtah’s VP for Government Affairs, Denise Bell, along with a coalition of patient advocates, life sciences executives, pharmacists, physicians, oncologists, and community organizations, held a lunch meeting with Representatives Blake Moore (R-UT) and Celeste Maloy (R-UT) October 1 to discuss the dangers of giving pharmacy benefit managers (PBMs) command over how much patients pay for drugs and where they are purchased.

The lunch was held at the Utah Cancer Specialists Administrative offices.

BioUtah members, Colin Hill, general manager and head of clinical operations, North America for bioMérieux, and Frank Wantanbe, president and CEO of Arcutis, were on hand to share their perspectives on how PBMs influence healthcare and the drug supply chain.

Both Moore and Maloy expressed support for passing PBM reform, although they acknowledged obstacles to getting legislation enacted before year’s end.

Prior to the lunch event, a number of Utah pharmacists from across the state gave Maloy a first hand look at how PBMs impact the operations of independent pharmacies, including dictating lower reimbursements, favoring higher cost drugs, and steering patients to the pharmacies owned by the PBMs. Pharmacist Kevin DeMass, opened up his pharmacy, the Apothecary Shoppe, for the visit. FTC Commissioner, Melissa Holyoak, joined Maloy to learn more about how pharmacists and patients are being squeezed by PBM practices. Holyoak was previously solicitor general for the Utah State Attorney General’s office. The FTC is suing the three largest PBMs for anticompetitive practices.

The data speaks volumes. The largest three PBMs control nearly 80% of all the prescription drug business in the nation. This market power is further exacerbated by vertical integration. Five of the six largest PBMs are now owned by entities that also own insurers, specialty pharmacies, and providers. Such dominance, undermines market competition that would otherwise result in downward pressure on the cost of medicines. 

PBMs raise drug costs by almost 30% due to the rebates they charge manufacturers to be on their formularies – rebates not passed onto to consumers.

A realignment of incentives in the PBM business model is needed to address anti-competitive practices, ensure patient choice, and lower the cost of medications for patients in Utah and across the country. To that end, BioUtah and its coalition partners support the following comprehensive PBM reforms in Medicare, Medicaid, and the commercial market.

• Transparency reporting requirements.
• Delinking.
• A ban on spread pricing.
• Prohibiting patient steering to PBM pharmacies.