Pharmacy benefit managers stand in the way of innovation (Your Letters) Leave a comment

To the Editor:

Every day, millions of Americans rely on access to innovative prescription medications to treat chronic and acute diseases. According to the Center for Disease Control (CDC), 60 percent of American adults live with a chronic illness of some kind. Many of these people require frequent, if not daily, treatment to remain healthy and maintain a positive quality of life. The biopharmaceutical industry’s aptly named research and development (R&D) arm provides people precisely that. The industry’s innovative efforts produce a variety of life-saving treatments, resulting in widely available prescription medications to those who need them most. But now, that R&D is under threat.

Biopharma firms currently face an established middleman in the U.S. healthcare industry that reduces their capacity for innovation. Pharmacy Benefit Managers (PBMs) negotiate drug prices on behalf of large employers, health plans and Medicare Part D. As go-betweens in the prescription supply chain, PBMs have found many ways to skim gains in the current drug pricing scheme. They create little to no value for consumers and divert profits from R&D — all to the detriment of those living with chronic illnesses who depend on innovative medications to survive.

Those affected by multiple sclerosis (MS) know this reality all too well. MS is a disease that affects the central nervous system, including the brain, spinal cord and optic nerves. The illness causes an auto-immune response of inflammation in which the immune system attacks the protective covering of nerve fibers. This immune response results in a lack of communication between the brain and the body, inhibiting the proper function of the body’s interrelated systems. MS is a highly unpredictable disease, producing mild symptoms for some while others face more severe disabilities.

Over 400,000 Americans are diagnosed with MS, for which there is no cure. However, various treatment options are designed to slow disease progression and prescriptions to manage symptoms. Often, MS patients must try multiple types of treatment to find one with minimal side effects that interfere with day-to-day life. For those living with MS, like others with chronic illnesses, the R&D innovation of prescription treatments is of the utmost importance. Without access to essential medications, individuals with MS face dire consequences. America cannot allow this to happen — we must prioritize healthcare innovation.

Unfortunately, pharmacy benefit managers have other ideas.

These healthcare middlemen negotiate drug prices between biopharmaceutical firms and healthcare outlets. In the process, PBMs siphon funds away from R&D, hindering key innovative projects that could potentially help millions of Americans. Furthermore, PBMs retain the savings that should benefit the public at the pharmacy counter. In short, PBMs limit healthcare innovation to benefit their bottom lines — and that is, quite simply, unacceptable.

With reduced revenue streams to biopharmaceutical R&D, companies become increasingly unable to fund innovative treatments and cures. Prescription drug manufacturers rely on venture capital to create and produce prescription treatments. Without the prospect of sufficient returns on investment (ROI), firms innovating drugs will lack the financial backing to develop medicines that save and improve lives. This primarily harms those with chronic conditions that require ongoing treatment like MS.

As it stands, PBM’s profiteering behavior harms those living with chronic illnesses like multiple sclerosis. These firms reduce revenues for the R&D of innovative treatments and cures, leading to decreased availability and choice of essential medications for consumers. Access to life-improving and, indeed, life-saving treatments is not a luxury but a necessity. To fight for those across the nation with rare and complex conditions who depend on biopharmaceutical innovation, we must re-examine the role of PBMs in our healthcare system.

Annette Simiele

Associate Director

Multiple Sclerosis Resources of Central New York

East Syracuse

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