Washington, D.C. – Justin Leventhal, Senior Policy Analyst at the American Consumer Institute (ACI), has submitted comments to the Centers for Medicare and Medicaid Services (CMS) addressing critical issues in the Medicare Part D and Medicare Advantage programs. ACI’s analysis reveals the troubling impact of Pharmacy Benefit Manager (PBM) practices on the affordability and accessibility of generic and biosimilar medications, underscoring the urgent need for transparency and regulatory reform.
Key Takeaways – Addressing PBM Practices in Medicare Part D and Medicare Advantage
Read the full comment here.
- PBM Incentives Favoring High-Cost Drugs: PBMs often prioritize expensive brand-name drugs with larger rebates over more affordable generics, creating financial barriers for patients and inflating overall healthcare costs.
- Spread Pricing Concerns: Many PBMs retain a significant portion of manufacturer rebates instead of passing savings to patients, exacerbating the affordability crisis.
- Transparency Deficiencies: The opaque pricing mechanisms of PBMs hinder insurers and consumers from making informed choices, fostering a system that rewards profit over patient welfare.
ACI calls on CMS to adopt stronger transparency and reporting requirements for PBMs, compelling them to disclose rebate structures and formulary practices. By improving accountability and encouraging competition based on value rather than opaque pricing, CMS can reduce drug costs and enhance access to affordable medications for seniors.
For media inquiries, please email [email protected] to inquire about the above content.
The American Consumer Institute is a nonprofit education and research organization. For more information about the Institute, visit www.TheAmericanConsumer.Org or follow us on Twitter (X) @ConsumerPal.