Dear Neighbor,

Prescription drug prices are unjustifiably too high, and I remain committed to fighting at every turn to make prescription medications more affordable and accessible to people who need them.

Yesterday, I participated in a congressional hearing where we examined the significant role pharmacy benefit managers (PBMs) play in the payment and supply chain processes that increase drug costs for consumers and potentially harm patient care. The hearing was convened by the United States House Committee on Oversight and Accountability on which I serve.

PBMs are companies that manage prescription drug benefits for health insurers, large employers, Medicare, Medicaid, and similar organizations. Some PBM practices, such as rebate negotiations and prior authorization requirements, may result in higher drug costs and unnecessarily limit patient access to certain medications. Moreover, certain PBM practices, including spread pricing and less than transparent fees charged to pharmacies, have an outsized effect on independent and community pharmacies and the rural and underserved communities they serve.

PBMs also utilize medical management techniques like prior authorization, which
requires a health care provider to provide approval to a pharmacy before the pharmacy can dispense certain medications without the patient having to pay a higher price—sometimes the full list price of the medication. Another common medical management technique is called step therapy, where patients must first try a less expensive medication before the more expensive medication initially prescribed will be covered.

In a 2022 survey of American Medication Association members, 94% of the physicians surveyed reported that prior authorizations delay access to necessary care, 89% reported that prior authorizations have a somewhat or significant negative impact on patient clinical outcomes, and 80% reported that a prior authorization can lead to patients abandoning the recommended course of treatment.

People are dying while companies are profiting. That is why I used my participation in yesterday’s hearing as an opportunity to call for bipartisan participation in legislation to address the outrageous tactics subtly taking place all around us.

My remarks from the hearing can be viewed below. At certain points, I shared the stories of two constituents from the Greater Baltimore area, Kyle and John, who are real people, with real families, facing real crises as a result of the business practices of PBMs and the drug manufacturers. There accounts were recorded from the 2022 Prescription Drug Affordability Community Forum's report. 

WATCH: Congressman Mfume's Remarks on Big Pharma Business Practices 

Kyle’s wife from Baltimore has lupus, as well as degenerative disc disease, and is currently on multiple medications. The cost of her prescriptions amounts to $1,200 every three months, and her doctor’s visits add an additional $1,000 every 3 months. Kyle is retired but had to return to work in order to qualify for benefits in order to support his wife’s medical expenses and keep her alive.

John from Baltimore was diagnosed with multiple myeloma and recently finished bone marrow treatment. John now takes 21 doses of Revlimid, and each pill costs $990. He needs this drug to keep his cancer under control and has been left with no other choice but to beg for generosity from the drug manufacturer.

I look forward to providing you with more updates on this issue as I continue to work on it on Capitol Hill.

Yours in service,

Kweisi Mfume
Member of Congress