Posted on July 02, 2021 in: Professional Practice
Bismark, ND -- The Alliance for Transparent and Affordable Prescriptions (ATAP), a coalition of physician and patient advocacy organizations dedicated to exposing the role the pharmacy benefit manager (PBM) industry has on rising prescription drug costs was joined by the Community Oncology Alliance (COA) and American Pharmacies in filing an amicus brief in PCMA v. Wehbi. The case, currently being argued in the 8th Circuit, Court of Appeals is a challenge to a North Dakota law designed to regulate abusive practices by the PBM industry.
The brief prepared by Daniel Geyser of Alexander Dubose & Jefferson LLP on behalf of ATAP, COA and American Pharmacies may be found here.
Following a ruling by the United States Supreme Court in Rutledge v. Pharmaceutical Care Management Association (where ATAP also filed an amicus brief), many states have begun to explore regulating the PBM industry to lower costs and increase access to therapies. That case resulted in a unanimous 8-0 decision where the Justices agreed that states have the right to impose regulations on PBMs.
Despite setbacks in legislatures and the courts, the PBM industry continues to raise challenges to state regulation of their practices and seeks to avoid accountability.
ATAP has been an active advocate for patients in a variety of federal and state battles to amplify the voices of patients and physicians – especially as it relates to exposing PBM abuses and their impact on patients’ access to therapies (medications) needed in their treatment.
Dr. Robert Levin, ATAP’s President stated, “We see first-hand how the PBM industry drives up costs and interferes with medical care. Doctors, patients, legislators and regulators are all saying, ‘enough is enough’ and fighting back. We appreciate the opportunity to argue on behalf of patients and defend our obligation to them as the Courts once again weigh in on regulating this rogue industry.”
“Oncologists remain troubled by the negative impact PBMs have on patient care and role they play in driving up costs,” said Kashyap Patel, MD, president of COA and a practicing medical oncologist at Carolina Blood and Cancer Care Associates in Rock Hill, South Carolina “PBMs are directly responsible for the loss of patient access to affordable, potentially life-saving medications for cancer and other serious diseases. COA is proud to share our voice and support to effort in North Dakota and nationwide to stop PBM abuses.”
“PBMs have used their outsized market power to raise community pharmacies costs of operation,” explained Miguel S. Rodriguez, General Counsel at American Pharmacies. “PBMs operate in secrecy and routinely fail to pass along any savings to patients. It is time to shine a light on and regulate this industry.” American Pharmacies is a nation-wide independent pharmacy cooperative that routinely advocates on behalf of independent pharmacies and the patients they serve.
ATAP, COA, and American Pharmacies argue in the brief that:
“…PBMs engage in harmful practices that impair optimal patient care, distort the free market, and impose serious costs on every major stakeholder in 5 the healthcare industry. States are ideally positioned to attack PBM misconduct; the regulation of healthcare is a traditional state function, and States routinely address market inefficiency and abuse, just as North Dakota did…”
“We are optimistic that the Courts will see through the previously hidden profit motives of the PBM industry,” said Dr. Angus Worthing of the American College of Rheumatology, an ATAP member organization. “With each new state law combined with other actions at the federal level, patients, physicians, and policy makers now have the power to effect meaningful change.”
“The Courts will surely see, like we all do, that patients are suffering under a system preventing them from obtaining medicine they need – at prices they can afford,” said Dr. Michael Schweitz of the Coalition of State Rheumatology Organizations, an ATAP member organization. “The PBM industry profits significantly off rebates and other schemes while interrupting the provider-patient relationship. It is time to do what is right and allow policymakers to stand up and do the right thing.”
“The profit motivations from the PBM industry impact real people in dangerous ways,” Dr. Levin continued. “ATAP members are on the front lines of medical care. We see the struggles and confusion that patients are put through by this completely unnecessary middleman industry. They deserve better – they deserve the truth – not dangerous interference from policies motivated only by profit.”
ATAP is working in many states to force the PBM industry to disclose rebate data and encourage transparency and reporting requirements for all entities involved in the prescription drug supply chain – PBMs, insurers, and manufacturers.