PBMs lower costs; drug manufacturers are the primary factor in high drug prices.

The fact that pharmacy benefit managers (PBMs) commend Congress for its recent bipartisan decision to further delay the rebate rule as part of legislation to address mental health and gun safety should not come as a surprise. The rebate rule is used as the counterfactual example of how to cut prescription drug costs in the ongoing discussion.

When I write, I like to base my arguments on solid facts and evidence. So, once again, I’ll cite several data points, all of which come from government agencies and objective, reputable third-party sources, demonstrating that the rebate rule has no effect on drug costs. The Congressional Budget Office (CBO) estimated that the rebate rule would cost taxpayers $177 billion over ten years, and the U.S. Department of Health and Human Services Office of the Actuary reported that Medicare beneficiary premiums could rise by up to 25%, benefiting drug companies’ profits.

It goes without saying that any action that increases Medicare recipients’ prescription expenditures should be carefully evaluated. The rebate provision should be permanently eliminated, particularly in light of the fact that the majority of seniors live on fixed incomes, the recent 15% rise in Medicare Part B premiums, and what may be ongoing inflation.

We acknowledge that far too many people struggle to pay for their prescription medications, and Congress and the administration are right to keep looking into ways to do so. Additionally, we are aware of how critical pharmaceutical innovation is in developing novel patient therapies. Both accessibility and affordability are required for healthcare. This brings up a larger dynamic that should be addressed beyond the rebate requirement.

Unfortunately, the pharmaceutical industry continues to promote a false narrative about the function of PBMs rather than engaging in a productive, pro-solution dialogue. It is typical to come across a news piece announcing a brand-new $7 million pharmaceutical company advertising campaign. Although noticeable and spectacular, these campaigns essentially amount to Washington, D.C., political noise that obscures the reality that only drug makers have the authority to choose the list pricing for their goods.

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