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Capitol Insider: 'The PBM robbed her of hope'; pharmacy benefit managers ripped in hearing

Pharmacy benefit managers found out during a congressional hearing what the turkey's gonna feel like Thursday:

Cooked to a golden brown.

For two hours Wednesday, witness after witness and representative after representative condemned the practices of the middleman in America's drug supply chain.

A sampling of the litany before Republicans on the House Committee on Oversight and Reform:

"With PBMs it's always a flim-flam game." — Ted Okon, executive director of the Community Oncology Alliance.

"It sounds like extortion." — Rep. Andrew Clyde of Georgia.

“Every single PBM engages in steering every single day for every single patient.” — Tiffany Jones, vice president of regulatory affairs at Dallas-based specialty pharmacy SenderraRx. She was referring to how PBMs find out when someone is using a competing pharmacy, then try to bully them into using a PBM-owned pharmacy.

"Hidden rebates allow PBMs to hide cost savings from patients and, increasingly commonly, charge them more than their fair share." — Erin Trish, co-director of the USC Schaeffer Center for Health Policy & Economics.

Such payments from pharmaceutical firms for an invaluable spot on the PBM's list of cover drugs "are kickbacks by any reasonable definition of that word." — Dr. Madelaine Feldman, president of the Coalition of State Rheumatology Practices.

Feldman described metastatic prostate cancer patients who must first try a $10,000 medication and not get better before their health insurance will cover a $350 generic drug, due to how PBMs set coverage tiers.

"Don't tell me that rebates and kickbacks don't have anything to do with it," she testified.

Rep. Diana Harshbarger, a pharmacist from Tennessee, responded, "You know what that's called? That's called pay to play. There's no other way to put it."

Okon told the panel, "I will never forget sitting ... with a sister and brother from Louisiana relating how their mom fought the PBM for two months to get her cancer drug, which she could have gotten immediately from her oncologist. A week after being admitted to hospice, their mom finally got her drug, but a week later she died.

"As the daughter related through tears, we don’t know if the drug would have saved her, but the PBM robbed her of hope. No cancer patient should be robbed of hope by a PBM."

The panel's top GOP member, James Comer of Kentucky, was sold:

"Pharmacy benefit managers must be held accountable for their role in rising prescription drug prices. In order to ensure transparency and competition, Congress must take on PBMs."

Trade group spokesman insists there is competition among PBMS

In response to the flurry of criticism, Kim Caldwell, the principal at Texas Star Healthcare Consulting who testified on behalf of the PBM trade group Pharmaceutical Care Management Association, said he could not respond to situations involving specific PBMs.

Although three PBMs control nearly 80% of the market, "there is competition out there," he said.

And if doctors can't get approval for insurance to cover a needed drug, there is always an appeals process, Caldwell added.

Taxpayers overpaying due to inflated drug prices, Ohio watchdog testifies

Antonio Ciaccia, former lobbyist for the Ohio Pharmacists Association, tried to get committee members to see the nationwide impact of PBMs' maneuvers.

Due to clawbacks — money taken from pharmacies by PBMs long after state Medicaid agencies deemed the drug purchases final — "official" drug pricing data kept by the states are "likely corrupted and untrustworthy," said Ciaccia, who now leads two private firms delving into prescription pricing.

"The bad news for you all is that these prescription drug overcharges are not unique to Ohio, not unique to Medicaid, and all the pumped-up drug prices are being matched with federal taxpayer dollars."

One of two Ohioans on the panel, Bob Gibbs of Lakeville, remarked, "That really sounds like an (anti-)trust, monopoly type of issue."

The other Ohio member, Jim Jordan of Urbana, did not attend.

Like Jordan, no Democrats on the panel attended even though they were invited, Comer said.

“Democrats have given a free pass to pharmacy benefit managers even though they play an outsized role in driving rebates and list prices of prescription drugs," the ranking GOP member said.

"Despite my request to Chairwoman (Carolyn) Maloney to hold a hearing to examine the role of PBMs, Democrats have decided to limit their drug pricing investigation to only pharmaceutical companies leaving a significant void in in the Oversight Committee’s review of drug pricing and many unanswered questions.”

A Dispatch request Wednesday to the New York Democrat's office for a response went unanswered.

'Giving Ohioans the finger'; Verbal tussle spices emotional session on redistricting

A verbal confrontation Wednesday between northeast Ohio GOP Sen. Jerry Cirino and Democratic "fair maps" activist Katy Shanahan captured the essence of the bitter debate over new congressional districts backed by Republicans who dominate the legislature.

After Shanahan testified against the proposed GOP map, Cirino chided the opponents for their series of accusations of lawmakers "not acting in good faith, giving Ohioans the finger, disregarding the constitution, disregarding the democracy that we live in, and you just called us cheaters.

"So I just want to comment that I find that a unique method of persuasion on the part of those opposing the bill. And it will have the effect that you probably intend."

Shanahan, Ohio state director of All on the Line, didn't back off: "With all due respect, you have all shown us quite clearly that it doesn't actually matter what any of us have to say, no matter how polite we are or how stern we are in our pleas."

She noted that Ohio voters overwhelmingly approved reforms of the secretive, highly partisan redistricting process from 10 years ago, but said GOP lawmakers essentially duplicated what happened a decade earlier by preparing an initial map in secret that likely would give Republicans a 13-2 advantage.

"That is a showing of bad faith. You cannot argue with a straight face that that is showing respect to a congressional redistricting process that Ohioans demanded be better than what we saw 10 years ago. ... You all are on one mission. And that mission is to preserve your own political power over the interest of Ohio and our democracy.

"So, you're right, a lot of what you are hearing today is exasperation, it's frustration, it's righteous anger that we have to stand here and beg you to care enough about our democracy to do the right thing."


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