Michael Beals is the lead rabbi at Temple Beth El, Newark, and the chair of the Delaware Council of Faith-Based Partnerships. He has served twice as the president of the Delaware Association of Rabbis and Cantors. The Rev. Robert Hall serves as the pastor of Salem United Methodist Church, Newark. He recently retired as the executive director of the Delaware Ecumenical Council on Children and Families, and has also served as the president of the Delaware Public Health Association, the vice president of the Health Education Network of Delaware and the vice chair of the Delaware Consumer Health Care Coalition.
It’s understandable to wonder why a rabbi and a reverend would be offering editorial commentary on an issue as seemingly secular as prescription drug pricing and the medication supply chain. It is because what would seem on the surface to be strictly a public policy issue has become nothing less than a systemic moral failure, one that is doing serious harm to people in our congregations, across Delaware and the entire country.
We have joined other members of the clergy in our state in a letter to Sen. Chris Coons, D-Del., urging him and his colleagues to act expeditiously in passing reform legislation to stop the current practices of pharmacy benefit managers. PBMs are corporations that determine whether patients can access their medications and how much they pay for those medications when they fill a prescription at the pharmacy. Every day in our communities, we are seeing the impact of what these entities are doing in the form of people losing jobs and patients being unable to afford the medicines they need.
Congressional committees, the Federal Trade Commission and multiple journalists have compiled volumes of information on how pharmacy benefit managers, essentially middlemen in the supply chain, are manipulating the drug-pricing process for their own profit. The six largest PBMs control 95% of the prescription drug marketplace, and they are combining with health insurers, mail-order and specialty pharmacies, and health care providers to form mammoth multinational corporations and a competition-free environment.
What they are doing with this power is unconscionable. They are demanding large rebates and discounts from drug manufacturers, keeping those dollars instead of passing them along to patients, and then, the PBMs are steering patients toward higher-priced drugs that generate the greatest profits for them. They are charging employers and governments far-higher prices to acquire drugs than they are paying the pharmacies that dispense them, and in fact, a report issued earlier this year described how a major benefit manager overcharged postal workers $45 million for medicines over five years. Their price manipulations are sometimes difficult to believe. One recent study found that such corporations were charging over $4,400 for a multiple sclerosis treatment that could be purchased at Mark Cuban’s Cost Plus Drug Co. for less than 20 bucks.
For so many Delaware households, the impact of these practices has been devastating. In the past year alone, multiple pharmacies in the state have closed, in no small part because pharmacy benefit managers reimburse them less to dispense medicines than it costs the drugstores to purchase them. Further, PBMs are encouraging customers to use their own mail-order and specialty pharmacies, pulling business away from community pharmacies. This is costing people their jobs and leaving too many neighborhoods without what had been a trusted health care center.
And, as the Federal Trade Commission pointed out in its report on these entities, nearly 3 of every 10 Americans are reporting that they are either rationing their prescriptions or skipping doses of necessary medicines because they can’t afford the out-of-pocket costs that, again, are determined by the PBMs.
There are solutions within easy reach for Congress. In fact, they’ve already been incorporated into legislation. Pharmacy benefit managers’ profits should not be connected to the price of medication, to remove the incentives to steer patients toward higher-priced drugs. And the managers should be required to pass cost savings to patients. In both the U.S. Senate and House of Representatives, there is genuine bipartisan momentum behind these ideas.
We are speaking out on this because this is undeniably a moral issue affecting the health and well-being of our communities and the people to whom we minister. It is simply wrong when anyone has to choose between food and medicine or when they lose their jobs and wonder how to keep a roof over their heads — all so a small handful of megacorporations can move a few spots up on the Fortune 500 list.
Congress has the ability to fix what is clearly broken, to make medicines affordable and enable neighborhood pharmacies to keep their doors open. In this case, the smart thing to do and the right thing to do are perfectly aligned.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org .
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