U.S. Sen. Martin Heinrich

U.S. SENATE News:

WASHINGTON, D.C. — U.S. Sen. 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 more than 300 independent pharmacy net closures — almost one per day. Unfortunately, that trend has only grown in 2024,” Heinrich wrote in a letter with his Senate colleagues. “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 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. Sen. 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. Sen. 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.