Cost-sharing

As the Subcommittee examines how reining in pharmacy benefit managers (PBMs) will drive competition and lower costs for patients, we urge Congress to pass meaningful reforms that will ensure patient access to life-saving medications and address the harmful, profit-driven practices of PBMs. For too long, pharmacy benefit managers have profited at the expense of patients living with chronic conditions. These middlemen, who now control 80% of prescription drug claims dictate, with little transparency or oversight, which medications insurers cover, how much patients pay and which administrative hoops patients and providers must jump through to access prescribed treatments.[i] PBMs exploit their dominant market position to extract profits at the expense of patients, particularly those managing chronic conditions such as cancer, diabetes, and HIV. Chronic conditions affect more than 130 million Americans and as of 2022, approximately 1.2 million people were living with HIV nationwide.