Ryan Costello: Pharmacy benefit managers help keep drug costs down

These days, it seems it is always political campaign season. That is true on the presidential level, with several candidates already seeking the Republican nomination. Here in Pennsylvania, we will also be electing a U.S. senator (Bob Casey’s seat) and a full state and federal House delegation next year. As the campaigns go forward, voters want to hear about solutions to their everyday problems.

One of those concerns is the cost of health care.

The public policy organization Pennsylvania Health Access Network polls people across our state. It finds that drug costs are a major concern. “The cost of prescription drugs created one of the largest affordability burdens, causing 1 in 5 of all Pennsylvania adults to cut pills in half, skip doses, or not fill a prescription,” the organization told state lawmakers in 2021. Further, “51% of all respondents reported being worried about affording prescription drugs.”

Nobody should have to choose between health care and other basic needs like food and shelter. Policymakers need to find ways to reduce costs to consumers. Instead, some are taking aim at one of the only tools that is already available and working to Pennsylvanians — pharmacy benefit managers.

PBMs were created because, with just a few conglomerates monopolizing the pharmaceutical industry, health care plan operators (the government, private businesses, unions, and insurers) knew they needed to pool their leverage to keep prices affordable. They did so by hiring PBMs, third-party administrators of prescription drug programs.

Like how lawyers advocate on plaintiff and defendants’ behalf in the courtroom, PBMs advocate on health plans’ behalf in drug price negotiations. They secure bulk discounts, push for the use of cheaper brands, and provide countless other services to keep drug prices low.

However, some pharmaceutical distributors don’t like their prices being challenged and have convinced lawmakers that PBMs use their power to pad their own pocketbooks rather than to advocate for the American people’s best interests. The facts tell another story to the drugmakers’ tale.

Former Pennsylvania Congressman Joe Pitts, then the chairman of a powerful congressional health subcommittee, led a 2015 investigation of PBMs. He said that “in preparation for the hearing, (he) looked deeper into the issue, digging beyond the anti-PBM talking points typically seen on lobbying sheets and high-dollar advertisements created by K Street” and quickly found that PBMs are not the boogeyman some drug companies make them out to be.

Pitts was right then, and he’s right now. PBMs have been nothing but a blessing for my former constituents. I have talked to many Pennsylvania county commissioners, unions, and businesses who have said that PBMs provide endless benefits to the people they serve.

The data confirms these anecdotes. Private studies have shown PBMs save patients nearly $1,000 per person a year. The Government Accountability Office, the supreme audit institution of the United States, also found they offset Medicare Part D spending by nearly $30 billion in a single year.

Pennsylvania can, and must, do more to help our residents get affordable healthcare. But that should come from introducing more competition across the state and the country, not tearing apart PBMs, which is exactly what the bad applies in the healthcare industry want the government to do.

Finding ways to reduce health care costs will be a major issue in Pennsylvania’s 2024 campaigns. PBMs should be considered part of every candidates’ answer rather than being considered part of the problem.

Ryan Costello is a former member of Congress from Pennsylvania.