COA to Testify at Congressional Forum on Pharmacy Benefit Manager Pricing

The forum will focus on PBMs’ disproportionate influence over the treatment of patients with cancer, as well as drug pricing and patient cost sharing.

Community Oncology Alliance’s (COA) executive director Ted Okon will testify before Congress on the impact of Pharmacy Benefit Managers (PBMs) on prescription drugs, COA announced in a press release.

Okon and other pharmacists and physicians are set to testify before members of the House Committee on Oversight and Reform. The forum will focus on PBMs’ disproportionate influence over the treatment of patients with cancer, as well as drug pricing and patient cost sharing. It will be hosted by James Comer (R-KY), the Committee’s ranking member.

Okon will specifically address the setbacks experienced by patients and practices caused by PBMs, including direct and indirect remuneration (DIR) fees that undercut pharmacists as well as medication delays that could harm or kill patients.

This is not a recent issue: COA has reported on the negative effect of PBMs for several years, with many patients calling it abuse. Some reports include stories of delayed delivery of critical cancer drugs, PBMs arguing with physicians and pharmacists over proper treatment, and completely denied coverage.

There has also been countless published research highlighting problems with pricing games and spread pricing. COA has also warned policymakers at both the state and federal levels that, without significant action, PBM abuses will undermine the landmark progress made in the fight against cancer.

“2021 has seen increased scrutiny of PBMs and legislation to rein in the corporate giants’ influence,” the press release said, noting that several states such as Georgia, Tennessee, and Texas have passed laws to increase transparency in the PBM industry. These laws also prohibit procedures—including DIR fees—and establish fair audit systems for local pharmacies.

Now that the issue has widespread attention, federal legislators are noticing and considering action at the national level.