WASHINGTON - U.S. Senator Martin Heinrich (D-N.M.) is urging Majority Leader Chuck Schumer (D-N.Y.) and Minority Leader Mitch McConnell (R-Ky.) to rein in damaging pharmacy benefit manager (PBM) practices that hurt patients and pharmacies.

PBMs are intermediaries that negotiate and manage prescription drug benefits on behalf of health insurance companies, self-insured employers, and government programs. Currently, three PBMs control nearly 80 percent of the prescription drug market and operate with little oversight by federal regulators and out of the view of consumers. PBMs influence prescription drug costs, determine which drugs are covered by an insurance plan, and pocket unknown sums of money that might otherwise be passed along as savings to consumers. This lack of transparency makes it difficult for the public and regulators to fully understand how the market drives up costs for consumers.

"The need to act is more severe now than ever before. In 2023 there were over 300 independent pharmacy net closures - almost one per day. Unfortunately, that trend has only grown in 2024. Pharmacies across the country have been forced to close their doors because PBMs have continued to reimburse them significantly less than it costs the pharmacy to even purchase the drug. This is unsustainable, especially for small family businesses. The impacts of these closures only hurt already-struggling communities by decreasing the number of quality health care providers and likely increasing costs for seniors," Heinrich wrote in a letter with his Senate colleagues.

Heinrich is a leader on PBM reform in the Senate, cosponsoring bipartisan legislation known as the Pharmacy Benefit Manager Transparency Act, which bans deceptive unfair pricing schemes, prohibits arbitrary clawbacks of payments made to pharmacies, and requires PBMs to report to the Federal Trade Commission (FTC) how much money they make through spread pricing and pharmacy fees.

In March, Heinrich and U.S. Senator Ben Ray Luján (D-N.M.) urged Senate leadership to take immediate action to reform PBMs in an effort to reduce the cost of prescription drugs.

The letter was led by U.S. Senator James Lankford (R-Okla.). Alongside Heinrich, the letter was signed by U.S. Senators Mark Warner (D-Va.), John Boozman (R-Ark.), Tim Kaine (D-Va.), Jim Risch (R-Idaho), Elizabeth Warren (D-Mass.), Thom Tillis (R-N.C.), Raphael Warnock (D-Ga.), Roger Marshall (R-Kan.), Angus King (I-Maine), John Cornyn (R-Texas), Jon Tester (D-Mont.), Chuck Grassley (R-Iowa), Catherine Cortez Masto (D-Nev.), Mike Braun (R-Ind.), Peter Welch (D-Vt.), Susan Collins (R-Maine), Maria Cantwell (D-Wash.), Kevin Cramer (R-N.D.), Gary Peters (D-Mich.), Markwayne Mullin (R-Okla.), Tommy Tuberville (R-Ala.), Mike Rounds (R-S.D.), Tammy Baldwin (D-Wis.), Chris Coons (D-Del.), Jerry Moran (R-Kan.), Joe Manchin (I-W.Va.), Jeanne Shaheen (D-N.H.), Shelley Moore Capito (R-W.Va.), Patty Murray (D-Wash.), Joni Ernst (R-Iowa), Maggie Hassan (D-N.H.), and Deb Fischer (R-Neb.).

The text of the letter is here and below:

Dear Majority Leader Schumer and Minority Leader McConnell,

We write to encourage you to include critically-needed Pharmacy Benefit Manager (PBM) reforms in any legislative vehicle that may be brought up for a vote at the end of the 118th Congress.

A number of committees in both the Senate and the House have passed meaningful legislation that would rein in certain PBM practices that harm patients and local pharmacies. In the Senate, the Senate Finance Committee nearly unanimously passed the Modernizing and Ensuring PBM Accountability Act and the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, the Health, Education, Labor, and Pensions (HELP) Committee passed the Pharmacy Benefit Manager Reform Act, the Commerce Committee passed the Pharmacy Benefit Manager Transparency Act, and the Judiciary Committee passed the Prescription Pricing for the People Act. These proposed policies would increase transparency, realign incentives for PBMs and patients, ensure pharmacies are adequately reimbursed, and ensure that patients benefit from decreased drug costs.

To not advance these important policies before the end of this Congress would be a waste of substantial progress made and would deny patients and pharmacists across the country the relief they deserve.

In December of last year, the Centers for Medicare & Medicaid Services (CMS) wrote to PBMs and plans: 'We are hearing an increasing number of concerns about certain practices by some plans and [PBMs] that threaten the sustainability of many pharmacies, impede access to care, and put increased burden on health care providers.' More recently, the Federal Trade Commission (FTC) released an interim report which noted that 'PBMs can often exercise significant control over which drugs are available, at what price, and which pharmacies patients can use to access their prescribed medications,' and filed a complaint alleging that 'PBMs have abused their economic power by rigging pharmaceutical supply chain competition in their favor, forcing patients to pay more for life-saving medication.'

The need to act is more severe now than ever before. In 2023 there were over 300 independent pharmacy net closures-almost one per day. Unfortunately, that trend has only grown in 2024. Pharmacies across the country have been forced to close their doors because PBMs have continued to reimburse them significantly less than it costs the pharmacy to even purchase the drug. This is unsustainable, especially for small family businesses. The impacts of these closures only hurt already-struggling communities by decreasing the number of quality health care providers and likely increasing costs for seniors.

Should any long-term policy priorities be attached to an end-of- year spending package, PBM reforms should be included in order to end the 118th Congress with success that will help protect pharmacies and decrease costs for patients across the country.

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