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WASHINGTON — The Pharmaceutical Care Management Association (PCMA) released the following statement ahead of the U.S. Senate Committee on Health, Education, Labor & Pensions (HELP) hearing, “Why Is Novo Nordisk Charging Americans with Diabetes and Obesity Outrageously High Prices for Ozempic and Wegovy?”
“In the HELP Committee hearing Tuesday, the drug company executive testifying will redux Big Pharma’s favorite messaging tactic of pointing the finger at pharmacy benefit managers (PBMs). This blame game is meant to shift attention, avoid accountability, keep drug prices high, and advance an agenda that would mean even higher profits for Big Pharma at the expense of patients, employers, and taxpayers. Lawmakers must reject falling into this trap, hold brand name manufacturers accountable for patent abuse that prevents competition from more effectively lowering prices for patients, and protect market forces in health care that counterbalance Big Pharma’s pricing power.
“While those intent on advancing an ideologically-driven, pharma-aligned agenda targeting PBMs are focused on telling a biased and incomplete story about a crisis of affordability on insulin that PBMs worked to address over the last six years, PBMs are engaged in the pressing work of helping patients, employers, and other health plan sponsors navigate the urgent challenge of the day posed by Big Pharma’s egregious pricing of GLP-1 drugs for diabetes and weight loss.
“Brand name manufacturers set prices on the products they market and their abuse of the U.S. patent system blocks competition from more affordable options for patients. The same price hiking, competition-blocking strategy Big Pharma used to keep prices high on insulin and other medications critical for the treatment of diabetes, is being applied to maximum effect on GLP-1s for weight loss, with the potential to impose disastrous costs on America’s employers, unions, and government health programs.
“PBMs are the only entities in the health care system working to mitigate the impact on patients, employers, and taxpayers of Big Pharma’s outrageous prices on blockbuster GLP-1s facing minimal competition. The critical value of PBMs is being demonstrated in real-time as they are effectively helping plan sponsors navigate a challenging balance between access and cost on GLP-1s for weight loss.
“One brand name manufacturer admitted on a recent earnings call that PBMs have been effective in securing savings on their high-priced GLP-1 products. If misguided pharma-backed proposals targeting PBMs were to pass into law, the effectiveness of the only proven counterbalance to brand name manufacturers would be curtailed, and egregious GLP-1 prices alone would threaten to bankrupt employers, union benefit funds, Medicare, and patients through higher out-of-pocket premiums.
“PBMs are using their expertise to actively support health plans and employers that decide covering GLP-1s for people seeking to lose weight is the right decision for their prescription benefits. They are offering employers and health plans comprehensive programs to help the right patients gain access to these treatments, combined with services that will help maximize the chances of long-term treatment success.
“For example, Optum Rx launched their innovative Weight Engage program, which drives appropriate use of GLP-1s and creates a more holistic approach to improved outcomes by combining diet and exercise support programs with GLP-1 utilization for patients that meet the criteria. MaxorPlus also offers their Care Improvement Program to clients, aimed at patients with specific disease states allowing for the identification of opportunities for pharmacist intervention, including specific interventions with GLP-1 medications.
“Another example is Evernorth/Express Scripts’ industry-first EncircleRx program, which sustainably supports access for patients who need GLP-1s the most, while guaranteeing clinical outcomes and financial predictability for clients. CVS Caremark takes a three-pronged approach that provides their clients with solutions that include options for coverage, cost management, and clinical care solutions to help manage GLP-1 spending.
“These innovative programs are designed by PBMs of all sizes to help clients navigate an increasingly complex space. The PBM industry is continuing to develop programs that meet the unique needs of the clients they serve, representing yet another way that PBMs are evolving to remain dynamic and competitive.”
Learn more about GLP-1s for weight loss and how PBMs are rising to the challenges HERE.
