E-Newsletter

Recently, I was in line at my local pharmacy to pick up a prescription for my son. Ahead of me in line was a woman picking up her prescription. While waiting for my turn, I overheard the conversation happening between the woman and the pharmacist.

The pharmacist informed her that her prescription, which used to have a $45 copay, would now cost $240. I suspect this is because the Pharmacy Benefit Manager (PBM) required the drug manufacturer to raise their price.

PBMs do this because they charge a percentage of the list price, so while they claim a higher discount offsets the price for the consumer, it doesn’t always work out that way. And if you have a medicine that is working, PBMs manipulating the price to enhance their profits is not appropriate.

In this situation of course, I couldn’t help but interject. I asked the woman if she had inquired about the cost of her drug without insurance, because we have heard testimony that due PBM manipulation and a lack of transparency in drug pricing, it might be cheaper if she paid cash than use her insurance.

Further, in this scenario, you can be required by your insurance company/PBM to try a new medicine. This also requires consultation with your doctor, and you may be like the lady at my pharmacy, who wasn’t able to get her medicine that day and left to consult her doctor.

The point of health insurance is so that if we get sick, or need medication, we are not financially devastated by the high costs associated with the health care we receive.

Unfortunately, with respect to prescription drugs, the incentives for insurance companies/PBMs are backwards.

The insurance companies should be acting in a quasi-fiduciary relationship with their insurers. After all, the insured, his/her employer, or a government run program is paying the insurance company to protect the insured from high-cost medicine, not help raise the cost.

That’s why I introduced H.R.3285, the Fairness for Patient Medications Act. It ensures that no patient pays more than the price their insurance company or PBM negotiated for the drug.

Under my bill, if the drug is highly-rebated, a patient would not be required to pay more than the insurance company is paying for the drug from the previous year once all the discounts are accounted for.

In other words, your insurance company, or their PBMs, shouldn’t be making extra profit by charging you a higher copay than they paid for the medicine themselves.  

Bottom line, this legislation is about fairness.

This bill is included in the larger legislative package, the PATIENT Act of 2023, which has passed out of the Energy and Commerce Committee and hopefully will be on the House floor soon.

H.R.3285 isn’t the only legislation I have been working on in the prescription drug space this Congress.

I’ve also introduced H.R.4099, the RECONNECTS Act of 2023, which amends the Public Health Service Act to reauthorize the prescription drug monitoring program for an additional five years in an effort to prevent overdoses of controlled substances.

This program allows for greater collaboration and tracking of opioids within states and across state lines.

It is important that our monitoring efforts extend across state lines, as many folks live short distances from state borders and can cross state lines to access prescription drugs. The 9th District is no exception.

Whether it be Martinsville, Bristol, Bluefield, or Galax – it’s important that health authorities are able to receive complete information about prescribing and patient behaviors in a timely fashion in order to facilitate a meaningful response.

H.R.4099, as part of the larger SUPPORT Act of 2023, will next be considered by the full E&C Committee.

The SUPPORT Act is itself a reauthorization of the SUPPORT for Patients and Communities Act, a bipartisan bill, passed in 2018, to address the opioid crisis.

In a recent field hearing in Gettysburg, Pennsylvania, the Committee examined the impact of the legislation five years on. We heard from Emily Keller, Special Secretary of Opioid Response, Office of Maryland Governor Wes Moore. When I asked her if the prescription drug monitoring program was working, she said she “had seen success.”

This program was in the bill I wrote, which was included in the 2018 Support Act, to enhance prescription drug monitoring across states.

I and other E&C Republicans have made tackling addiction and real drug price reform and transparency a top priority of this Congress. Like the lady at my pharmacy, we all should know the real prices of our medicines.

If you have questions, concerns, or comments, feel free to contact my office. You can call my Abingdon office at 276-525-1405 or my Christiansburg office at 540-381-5671. To reach my office via email, please visit my website at www.morgangriffith.house.gov. 

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