[Congressional Record Volume 170, Number 190 (Friday, December 20, 2024)]
[Senate]
[Pages S7268-S7269]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Pharmacy Benefit Managers
Mr. WYDEN. Mr. President, earlier this week, Democrats and
Republicans from both the House and the Senate made a deal that struck
a blow against the healthcare middlemen that manipulate our healthcare
system to enrich themselves.
Unfortunately, the very first act of the second Trump
administration--or should I say, the first Musk administration--was to
step in and strip out the bipartisan agreement that stops the drug
middlemen known as pharmacy benefit managers from ripping off taxpayers
and seniors.
We all understand that healthcare is an unavoidable expense for most
American families. That is why I went into public service. Healthcare
is not a Democratic or a Republican issue; it is a family issue. And we
know if you or your loved ones don't have their health, everything else
in the house goes by the board.
Unfortunately, the chaos sown by the President-elect and his
billionaire ``mini-me''--though, again, it is hard to tell which is
which--they serve to protect the middlemen, the pharmacy
[[Page S7269]]
benefit managers, and insurance companies that take money out of the
system while our families are stuck with big medical bills and
substandard care.
Donald Trump has spent the last 2 weeks telling everybody who will
listen that he wants to take on the drug middlemen. Let me quote Donald
Trump here. He said:
They're rich as hell.
We're going to knock them out.
Well, at the very first opportunity to do that, he abandoned that
pledge in order to follow Elon Musk's lead.
You don't choose to do business with pharmacy benefit managers, but I
will tell you, they are dining out on your paycheck, nevertheless.
These PBMs squat between Big Pharma and the insurance companies. While
they are supposed to negotiate coverage and the price of prescription
medicine for your insurance plan, they have ended up favoring higher
priced drugs by taking a fee that is linked to the price of the drug.
The effort to reform these PBM practices has been bipartisan from the
get-go. It ought to be a no-brainer. I think I told the President of
the Senate, the Senator from Idaho, Senator Crapo, and I kicked this
effort off 2 years ago when the Senate Finance Committee passed a bill
26 to 0 and the House of Representatives has worked in a similarly
bipartisan way.
Our legislation would end the practice of profiting off higher prices
in Medicare by ensuring that a PBM can only receive a flat fee from
drugmakers. That is going to save taxpayers' and seniors' hard-earned
dollars because, finally, these pharmacy benefit managers are going to
have an incentive to pick lower priced drugs.
Let me just pause on that point for a second. These middlemen are not
the good guys. Earlier this week--and I heard my colleagues talking
about matters involving opioids--the New York Times reported that in
negotiations with opioid manufacturers like Purdue Pharma, the pharmacy
benefit managers traded away protections designed to reduce the rate of
opioid overdoses and addiction in order to make yet another fast buck.
These are the people Donald Trump is letting off the hook at Elon
Musk's direction.
The bipartisan agreement, I might also add, is particularly important
for us Westerners because we have seen our small, independent community
pharmacies hit so hard. These small businesses have been closing their
doors at an alarming rate over the past decade, again, in large part,
due to the practices by these PBM giants. The pharmacy benefit managers
are able to pay independent pharmacies whatever they feel like and then
the little pharmacy in Arizona or Oregon or Idaho or anywhere else--the
small pharmacy has to accept what the PBMs will pay.
What we do in our bipartisan legislation, what a number of committees
in the Senate have worked on--what has been the effort in the House and
what our program is all about is giving the small pharmacies a chance
to fight back by reporting unreasonable contract terms to a Federal
watchdog who is in a position to enforce a fair contract.
That is going to mean that independent community pharmacies are paid
what they are owed and keep their doors open in rural America without
having to pay off the PBMs by gouging customers.
Beyond the drug middlemen--I am just going to mention several other
areas that the bipartisan legislation cracks down on in terms of
helping the American people. The bipartisan legislation goes after
ghost networks that are blocking Americans from getting the care they
need. What these ghost networks are all about is, essentially, the
insurance companies take your money, and then there aren't any
providers, there aren't any navigators, there isn't anybody to help you
get your coverage.
So under what we are calling for in a bipartisan way, the insurance
companies would have to have a list of doctors that actually are going
to make care available so Americans who need care can contact them,
make an appointment, and not have to pay extra costs by going out of
the healthcare network they paid for.
Too often, based on investigations conducted by the Government
Accountability Office, as well as the investigative staff in the
Finance Committee, we have found that, essentially, these ghost
networks mean there is no: There, there. You paid your money, and you
can't get access to real care. Either the doctors don't take new
patients, nobody picks up the phone, you aren't able to get what you
paid for.
Finally, the bipartisan agreement--that Donald Trump has directed be
rejected. The bipartisan agreement strengthens requirements for
insurance companies that sell Medicare Advantage plans to make sure
that their directories are actually up to date.
Once again, we are seeing an area that cries out for reform because
Americans across the political spectrum are sick and tired of paying
premiums for health insurance, only to find they can't actually get
care when they need it. So Medicare Advantage, ghost networks, these
are the areas that we are strengthening in our bipartisan effort.
I will close by saying there is a lot more to like in the legislation
when it comes to healthcare, like continuing access to telehealth and
Medicare.
Again, Mr. President, bipartisan.
The late Senator Orrin Hatch negotiated with me the Chronic Care
bill, which had telemedicine provisions which became the foundation for
what we did to fight COVID--again, during the Trump administration.
But we are not getting the benefits of telehealth if we reject this
bipartisan agreement, as Donald Trump is urging. Telemedicine is in our
package and higher funding for community health centers.
I want to commend Senator Sanders and Senator Cassidy for working in
a bipartisan way on that. And we also have improvements to help moms
and kids and Americans with disabilities and seniors with Medicaid
coverage. Those, of course, are the dual eligibles, the folks who are
eligible for Medicaid and Medicare.
I come to the floor simply to say, we have the holidays coming up.
Everybody understands that. But there is another gift we can give to
the American people, and that is a more fair shake in American
healthcare.
We are spending enough money, Mr. President. We are spending over $4
trillion. There are 330 million of us. Divide the 330 million into $4
trillion, you could send every family of four in America a check for
more than $50,000 and say: ``Get your healthcare.'' We are not spending
it in the right places. I will tell you, in many instances, the reason
that is the case is because of these middle men. They made sense 30
years ago when you didn't have all the technology and all the data and
people who knew how to use it. But today, these pharmacy benefit
managers are, in too many instances, ripping off seniors and taxpayers.
And I hope Donald Trump will see that our bipartisan bill is important
to do now; important to do before we go home and get some relief to
seniors and taxpayers.
I yield the floor.
The PRESIDING OFFICER. The Senator from Tennessee.