newYou can now listen to Fox News!
Why is it difficult to get Medicines that your doctor prescribes? Why do patients and families spend countless hours of fighting for normative care treatments? Why are possible drugs to save life for weeks or months?
It can be blamed for these questions often on one of the least understanding Health care problems todayThe role of the pharmacy entitlement managers (PBMS). These powerful brokers – not your doctor – are increasingly deciding the medications you get, how you pay them in exchange for them, and where you get them.
My League as CEO gave me the Pontherreen Cancer Center a seat in the front row for a regular dysfunction.
PBMS was originally created to reduce the costs of medications and simplify access to medications. (Istock)
My 19 -year -old daughter recently faced a medical condition that requires a standard treatment of her doctor's care. Even with my professional experience, her doctor and I spent countless hours in fighting with PBM to agree to the medicine. It was finally approved in February, but it still takes 10 weeks before you can reach it.
Here is how Trump's tariff on China can affect drug pricing and other health care costs
In every step on the road, we faced a system that no one wanted to take responsibility; Pass the problem after the other like the hot potato game. Psychological losses for this ordeal – upon her, our family and their medical team – go beyond words. If you, with all the resources and knowledge at my disposal, I cannot cut this red tape, what is the hope that any other American has?
Unfortunately, this is not an isolated accident. Millions of patients throughout the country face similar barriers: forced to withstand denial, delay and disturbances for care due to the increase PBM suffocated on medicine.
This is not just an administrative inconvenience; They are life -threatening obstacles. Patients with cancer, chronic conditions, or rare diseases are discovered in a system that appears to be estimated by PBM's profits on human life.
Trump signs the executive order to make health care prices “transparent”
PBMS was originally created to reduce the costs of medications and simplify access to medications. Over time, they turned into entities that manipulate the system to increase profits at the expense of patients.
Which makes clay worse is the vertical integration that allowed PBMS to control each aspect of the prescribed medications supply chain. Today, the largest PBMS – Caremark RX, LLC (CVS), Express Scrips, Inc. (ESI), Optumrx, Inc. (OPTUMRX) – Not only runs the benefits of drugs. They are also Owning pharmacies Which fills the prescriptions and insurance companies that pay them.
This means that they have a financial incentive to determine the priorities of their own profits in each step: directing patients to their pharmacies, limiting access to competing medicines and increasing costs outside the pocket. With approximately 80 percent of the prescribed medications that are only controlled by these three PBMS, their decisions are almost health care experiences for each American. This vertical integration enhances energy in ways that simply harm patients.
How can Trump multiply the prices of prices for patients
The FBI Committee recently revealed how the three major PBMS falsified the pharmaceutical supply chain to amplify and achieve its profits. FTC The latest reportWhich was released in January 2025, highlighted how PBMS added major signs to specialized genetic drugs, amplifying cancer costs, HIV and other life -saving drugs.
Even in light of the federal investigation, the FTC report shows how these brokers achieved $ 7.3 billion of revenues from 2017 to 2022 by directing patients towards their pharmacies, paying themselves at higher rates of independent competitors, and participating in predators such as proliferation.
However, despite the increasing evidence and the call for the two parties to reform, Congress failed to act At the end of 2024. This lost opportunity is more than disappointing – it's dangerous. Patients cannot wait while legislators play politics.
The prices of the prescribed medicines increased by almost 40 % over the past decade
Congress must take immediate action to pass a meaningful PBM repair. House Energy and Commerce's sub -committee has recently held a hearing to discuss inflation driven by PBM, barriers to care, and market unification. The certificate has reinforced what patients and professionals in the field of health care already know: PBMS increases costs and limits access, not to reduce them.
These reforms have broad support from the two parties and represent real solutions. Patients deserve more than mysterious obligations; They deserve to work.
president Donald Trump Make the elimination of waste, fraud and ill -treatment in the government the cornerstone of its administration agenda. PBM reform is a clear extension of that task-these brokers have exploited shortcomings for a very long time, and it is time to restore transparency, fairness and the first patient policies of the system.
Congress must pass a meaningful PBM reform – not tomorrow but today. For my daughter and many of the patients I have fought over the years, this is not an abstract discussion of politics. It is real, it's urgent and it is very personal.
It is time to put patients before profits and politics. Congress was absent from a decisive opportunity in 2024. Let's make the year 2025 in the year when we stop the life -threatening PBMS and the restoration of humanity to health care. For my daughter and our loved ones, we cannot wait anymore.
