Mailbag: Pharmacy benefit managers, Republicans want to ‘fix’ Staunton

Virginia needs Congress to look into PBMs

In 2022, Congress scored a victory for the American people when it passed legislation allowing Medicare to negotiate directly with drug companies over the cost of some prescription drugs.

In 2024, Congress should turn its attention to a new cause of rising drug costs: America’s biggest pharmacy benefit managers (PBMs).

PBMs started decades ago as middlemen in the healthcare system. In the beginning, PBMs sat between insurance companies, pharmacies, employers, and drug manufacturers and helped connect each side.

Today, the largest PBMs no longer sit in the middle of the prescription drug market. The biggest PBMs have been acquired by large health conglomerates that are using the entities to generate billions in profit at Virginians’ expense.

My life’s work is making sure that Virginians can access the mental and physical health care they need. This often requires medication. I am in our community across central Virginia every day and I know when programs and policies are or are not working for our citizens. Even Virginians who are unfamiliar with the term PBM have likely encountered one. For consumers with health insurance, PBMs determine what drugs are accessible, when they are accessible, and how much a prescription costs. It is a model that is not working for consumers.

The three largest PBMs control 80 percent of the prescription drug market. Their profits increased from $6.3 billion in 2012 to $27.6 billion in 2022.

PBMs rising profits have had to come from somewhere, and several recent examinations have determined that patient pocketbooks are one source. PBMs and insurers are raising costs on consumers far faster than drug prices are going up. For example, while the net prices for brand drugs that drug companies have received is increasing only 1 percent annually, out-of-pocket costs for those same drugs have rose 50 percent between 2014 and 2022.

One issue that Congress must address is how PBMs use rebates or discounts to enrich insurance companies at the expense of patients. The big PBMs negotiate rebates from drug companies in exchange for placing drugs on insurance company’s plans. This means the price PBMs, and insurance companies pay for prescriptions is lower than the published price.

Curiously, the PBMs and insurers do not calculate their customer’s co-pays and other out-of-pocket expenses using the lower, rebated price. Instead, they charge patients based on the list price and use the difference to pad their profits.

There is evidence that PBMs are making more affordable prescriptions less accessible because they make more money when patients can only choose higher-priced alternatives. This is particularly true with insulin, where studies have shown PBMs have favored drugs that yield them higher fees. This practice is bad for patients.

Congress delivered a win to the American people when it brought drug companies to the negotiating table in 2022. Now, it is time to turn the spotlight on the big PBMs and their health care conglomerates.

Keisha M. Wright, M.Ed.

Republicans keep wanting to ‘fix’ Staunton

Republicans have shown Staunton time and time again that they do not care about our city. Recently Hung Cao, the Republican nominee running to challenge Sen. Tim Kaine, referred to our city and local newspaper, the News Leader, as “podunk.” Meanwhile, Kaine kicked off his re-election campaign in Staunton, speaking with a packed house of constituents about how to move our state forward.

Last year the city was inundated with comments from Wilson Fauber, former candidate for City Council, declaring the city depraved, insulting specific constituents, and calling the LGBT+ population of Staunton abominations multiple times. While his impressive defeat shows this as a losing strategy, Staunton was bombarded with divisive and hateful language for months, including after the election, where Fauber unleashed a tirade declaring he was planning on suing several individuals who stood up to his rhetoric.

These past few Republican candidates have been abysmal. It is obvious that Republicans continue to view Staunton as something to be fixed, instead of a beautiful city with many different people looking for a leader during hard times. I love this community and I want good leaders to move us forward. Republicans are again proving themselves incapable of the job. We deserve better.

Dylan Mabe