Getting your Trinity Audio player ready...

BY SEN. MARSHA BLACKBURN

When it comes to health care, one of the biggest issues Tennesseans face is access to affordable care.
Look no further than the rising cost of prescription drugs: According to the Department of Health and Human Services, prescription drug prices increased on average by more than 15 percent between 2022 and 2023, or roughly $590 per prescription. Nearly half of the medications the department studied saw price increases that outpaced inflation — including some with increases of over 3,000 percent.

These rising costs are unsustainable, which is why President Trump took executive action last month to lower drug prices for hard-working Americans, including by directing his administration to evaluate how pharmaceutical benefit managers, or PBMs, increase costs and limit choices for patients.

When we look at the prescription drug industry, we have pharmaceutical companies that manufacture medications, health insurers that cover them, pharmacies that sell them, and patients who rely on them. In this mix, however, are PBMs who act as middlemen between drug manufacturers, health insurers and pharmacies.

Decades ago, PBMs came along to assist employers with managing prescription drug costs and benefits. But over time, they have gained tremendous power over prescription drug access across our country, determining which medications will be covered by health insurance plans and the prices patients pay at the pharmacy counter.

PBMs’ control of the prescription drug industry is especially troubling because their revenue is often linked to the price of a drug. As a result, PBMs steer health plans toward more expensive prescription drugs, often tying administrative fees, rebate-based compensation and other payments to the list price of a drug.

To make matters worse, current regulations allow Medicare Part D plan sponsors to contract selectively with pharmacies and favor PBMs’ preferred networks, often excluding independent pharmacies that provide essential care for our rural communities. According to a recent audit conducted by the Tennessee Department of Commerce and Insurance, a single PBM in our state forced non-affiliated pharmacies to pay higher rates for more than 550 medications.

To hold PBMs accountable, I recently introduced the bipartisan Patients Before Middlemen Act. Among its measures, the legislation would restore fairness by requiring Medicare Part D plans to contract with any willing pharmacy, not just those in the narrowly tailored PBM networks.

It would also ensure PBM service fees are no longer connected to the price of a drug and create an enforcement mechanism requiring PBMs to pay the Department of Health and Human Services any amount in excess of the designated service fees.

As we work to lower prescription drug costs, we are also working to ensure that our nation’s veterans receive timely access to the quality care that they deserve.

All too often, the federal government fails to provide our nation’s veterans with the resources that were promised to them for their service, especially when it comes to the Veterans Health Administration. Last year under the Biden administration, for example, veterans had to wait an average of 22 days for a primary care appointment at VA facilities.

This is an inexcusable way to treat the brave men and women who have served our nation in uniform. To address this problem, I recently introduced the Veterans Health Care Freedom Act in the Senate. This legislation would place veterans at the center of the community care referral process, empowering them to seek care from providers in their communities rather than being forced to rely solely on VA facilities. This is especially important in Tennessee, where 78 of our 95 counties are considered rural and many vets face challenges reaching VA health care centers.

Congress should do everything possible to lower health care costs, expand access and help Americans lead healthy, productive lives. With the PBM Act and the Veterans Health Care Freedom Act, we have an incredible opportunity to do just that.

(Marsha Blackburn represents Tennessee in the U.S. Senate.)