St. Louis Reporter

The head of a Missouri health care reform group said the Congress and states should enact reforms that provide more transparency of the “present role” of Pharmacy Benefit Mangers (PBMs) in the health care system.

“The present role of PBMs in prescription drug markets is failing,” Connie Farrow, executive director of Patients Come First-Missouri, wrote in a St. Louis Post-Dispatch letter to the editor. “We urge Congress and states to consider reforms to increase transparency and ensure patients have access to affordable medicines and care they need in their community.”

Farrow's letter was in response to a Dec. 16 St. Louis Post-Dispatch article about independent St. Louis pharmacies closing due to financial challenges. The article specifically focuses on reimbursement rates from PBMs. These rates, reported the Post-Dispatch, often fall below the pharmacies' cost to acquire medications, leading to unsustainable business operations.

A PBM is a third-party administrator of prescription drug programs for health insurers, self-insured employers and government agencies. PBMs negotiate with drug manufacturers to secure discounts and rebates on medications, manage pharmacy networks, and process prescription drug claims. PBMs also provide services such as medication therapy management and mail-order pharmacy services.

The Federal Trade Commission (FTC) has released an interim staff report on the prescription drug middleman industry. According to an FTC press release, the interim report, required by a special order issued by the FTC in 2022, outlines how increased vertical integration and concentration have contributed to the rise of six PBMs that now manage almost 95% of the nation’s prescriptions.

The FTC asserts that this vertical integration and concentration have led to PBMs profiting at the expense of patients and independent pharmacists. “The FTC’s interim report lays out how dominant pharmacy benefit managers can hike the cost of drugs—including overcharging patients for cancer drugs,” FTC Chair Lina M. Khan stated in the press release. “The report also details how PBMs can squeeze independent pharmacies that many Americans—especially those in rural communities—depend on for essential care.”

Farrow told St. Louis Reporter in August that if the PBMs’ rebate system “functioned as it should, and as consumers are led to expect, patients would notice a reduced price for their medicine when paying at the pharmacy.”

“These discounts could mean the difference between patients getting a pricier advanced prescription that improves their health or not being able to afford a medication, skipping doses, or opting out of the care plan altogether. Given all of the advanced treatments and medications our healthcare system has to offer, it’s unacceptable that patients may have to skip a prescription because a discount wasn’t passed along to them,” Farrow said.

“Patients should feel encouraged that the FTC plans to investigate further how PBMs are manipulating the system and act accordingly to ensure patients and consumers are able to affordably access the medicines they need where they live.”

Patients Come First is a national advocacy group focused on eliminating barriers to care and improving medical innovation, particularly for those with chronic illnesses. It aims to ensure access to advanced care by creating a network of executive directors advocating for patients at the grassroots level.

Farrow has experience in public relations, patient advocacy, and journalism. She has been active in healthcare reform, advocating for patient and consumer issues related to access, affordability, and equity.