Republicans and Democrats find a unifying target: Pharmacy benefit managers
Amye Joseph says America's political polarization has made it an "interesting time" in her Tennessee household.
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it → find → household
But their shared disenchantment with profit-driven healthcare has provided a unifying target: pharmacy benefit managers, known as PBMs.
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disenchantment → share → PBMs
The Josephs' frustration is focused on CVS Health.
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frustration → focus → Health
The conglomerate, which reported $400 billion in revenue last year, includes a major health insurer (Aetna), one of the country's dominant PBMs (CVS Caremark), and America's largest retail pharmacy chain (CVS Pharmacy).
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which → report → PBMs
"We hate CVS.
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We → hate → CVS
I'm going to be straight-up," Amye Joseph said.
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Joseph → go → ?
She laments the lack of face-to-face interaction with pharmacists, prices that seem to rise without explanation, and pressure from the couple's CVS Caremark drug plan to use CVS stores instead of their local pharmacy.
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that → lament → pharmacy
"They're not even a middleman," she said.
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she → say → ?
PBMs were conceived as a way to manage prescriptions and hold down costs.
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PBMs → conceive → costs
But these middlemen have become bipartisan punching bags, accused of sucking up profits at the expense of employers, governments, and patients.
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middlemen → become → employers
And while healthcare debates still divide Democrats and Republicans in Washington, D.C., taking on PBMs has become a unifying cause in an era of widespread frustration over rising healthcare costs.
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taking → divide → costs
In recent years, every state has imposed restrictions on PBMs.
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state → impose → PBMs
The Josephs' home state of Tennessee, where the GOP has a lock on state government, is among a growing number looking to outlaw companies that own PBMs from also owning brick-and-mortar pharmacies, as CVS does.
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CVS → have → pharmacies
That's aligned conservative, business-friendly Republicans with Democrats, who are traditionally more open to government regulation.
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who → align → regulation
This legislative push reflects a feeling even in the GOP that the market for prescription drugs is being gamed, said Antonio Ciaccia, CEO of 46brooklyn Research, a nonprofit think tank that tracks drug pricing.
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that → reflect → pricing
"Republicans are looking at this issue, saying, We know what competition is supposed to do, and it isn't happening," said Ciaccia, a critic of the PBM industry.
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Ciaccia → look → industry
Charlie Joseph, a retired fire captain who now works as a custodian, was miffed when he realized he could save money on his blood pressure medication if he paid cash at his local pharmacy rather than using his CVS Caremark drug plan.
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he → work → plan
He now buys a 90-day supply for the same price he would have paid for a 30-day supply through the CVS plan.
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he → buy → plan
"Right now, it's more of an inconvenience than anything else as far as it goes, but there's no consistency," he said.
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he → go → anything
CVS spokesperson Phil Blando said the price of individual drugs can vary.
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price → say → drugs
"Looking at the price of a single prescription does not reflect the value of a comprehensive pharmacy benefit," he said in a statement.
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he → look → statement
"Our focus remains delivering the lowest possible total cost and the greatest overall value for members and plan sponsors."
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focus → remain → members
Unified opposition
PBM officials say their industry has been unfairly maligned.
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industry → say → ?
"PBMs are the only part of the prescription drug supply chain working to lower drug costs, which makes PBMs the target of powerful groups, Big Pharma and pharmacists," said Greg Lopes, a spokesperson for the Pharmaceutical Care Management Association, which represents PBMs across the nation.
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which → work → nation
"Drug manufacturers attempt to shift blame for high drug costs to PBMs in order to retain their profit margins and weaken PBMs' ability to lower costs," he said.
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he → attempt → costs
Drugmakers have worked for years to cast PBMs as unnecessary go-betweens, said Barak Richman, a lawyer and economist who studies healthcare competition at George Washington University.
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who → work → University
He called the fight between Big Pharma and PBMs a corporate "cage match."
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He → call → Pharma
"We have wildly passionate partisan divides on a lot of healthcare," he said.
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he → have → healthcare
"But there's a lot of healthcare policy that I don't think is obviously partisan."
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I → be → policy
PBMs haven't won over many Democrats or Republicans.
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PBMs → win → Democrats
Attorneys general from nearly 40 states and U.S. territories last year wrote a letter to congressional leaders arguing that "horizontal consolidation and vertical integration have transformed PBMs from useful administrative service providers into market-dominating behemoths."
In state legislatures like Tennessee's, shared ownership of PBMs and pharmacies has drawn particular fire.
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ownership → write → fire
Independent pharmacies have little choice but to contract with major PBMs while also competing with the conglomerate-owned pharmacies.
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pharmacies → have → pharmacies
Many lawmakers have said they want to protect small businesses.
"
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they → say → businesses
If a corporation argues that its pharmacy cannot survive unless it is owned by the same entity that sets the reimbursement rate, then we're not talking about a free market.
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we → argue → market
We're talking about control," Tennessee state Sen. Bobby Harshbarger said in a February legislative hearing.
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Harshbarger → talk → hearing
Harshbarger, a Republican who led the legislative push, is a pharmacist in a small city in northeastern Tennessee.
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who → lead → Tennessee
His mother, U.S. Rep. Diana Harshbarger, R-Tenn., is also a pharmacist and has sponsored a similar PBM ownership ban at the federal level.
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mother → sponsor → level
The Senate version has brought together some unlikely bedfellows, such as Sens. Elizabeth Warren, D-Mass. and Josh Hawley, R-Mo.
State lawmakers vs. CVS
CVS officials argued that the Tennessee legislation was misguided.
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legislation → bring → Warren
"Any proposed reform should be evaluated based on whether it improves access to care, simplifies the patient experience, and enhances affordability," Blando said in a statement.
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Blando → propose → statement
It's unclear whether the PBM ownership ban will do that in Tennessee.
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ban → do → Tennessee
…and 16 more, not listed.
The Aporia
