Nevada’s anti-PBM Bill Would Do More Harm Than Good
As someone who lives everyday with cancer, I understand how challenging it is for people to afford health care. Extreme out-of-pocket costs can deter individuals from seeking care, and rising prescription drug costs are a part of this problem. Earlier this year, big pharmaceutical companies hiked the prices of nearly 600 major brand-name drugs, including those to treat serious conditions like diabetes and cancer.
Hanna Olivas is a mom of five, founder of She Rises Studios, and lives with an incurable form of cancer.
To mitigate high costs, employers and unions often hire pharmacy benefit managers (PBMs) to secure rebates and discounts on medications for the employees whose health insurance they sponsor. Through negotiating with drug manufacturers and pharmacies on behalf of employers, PBMs are effective at lowering costs for employees and their families.
But a new bill circulating in Carson City – Senate Bill 316 – would upend this model and stick patients with higher premiums, taking us backward at a time when we need to be looking for solutions to enhance affordability. SB 316 would ban pay-for-performance incentives that encourage PBMs to secure more savings for the employers and unions that hire them – the more they save, the more they earn, and the people enrolled in those health plans see major savings on prescription drugs – an average of $1,040 for each patient a year.
PBMs also offer flexible options for patients at the pharmacy counter, including by securing generic drug options at a lower cost that fit the needs of patients. Additionally, patients can have multiple ways to receive their medications, whether they can make it to the pharmacy, or have their prescriptions shipped right to their door. This is especially critical for those with complex care needs or difficulties leaving the house.
While this model is extremely beneficial to secure low-cost health care, SB 316’s ‘delinking’ provision would dramatically impact the services of a PBMs, resulting in an environment where price-gouging and anti-competitive practices control the prescription drug market, as we’ve seen from Big Pharma time after time. Instead of seeing savings, Nevadans will see more than $200 million in increased premium costs in just the first year, according to an economic analysis of this policy.
Employers hire PBMs as a critical tool in securing affordable prescription benefits for their hardworking employees. For those, like me, facing chronic illness and complex diseases, and including children and seniors, affordability is key to ensuring the most vulnerable can access the treatments they need. SB 316 is harmful to these patients in Nevada, along with the hundreds of thousands of others who rely on their employer or union for their health coverage.
Nevada lawmakers cannot let health care prices rise for our patients across the state. Instead, they should be working towards lowering prices and making prescription drugs more affordable for every patient. This bill misses the mark entirely. It fails to deliver any beneficial terms for patients, their employers or the market forces that work to keep drug prices affordable, including through the work of PBMs.
The bill moves us in the wrong direction and undermines the tools that encourage PBMs to negotiate savings for patients, employers and unions. Instead, lawmakers must pursue policies that put our patients first, ahead of Big Pharma, and deliver lower costs and access to vital medications, especially for our most vulnerable residents.
