Legislation would crack down on pharmacy benefit managers’ rampant profiteering, verify patients aren’t duped into paying above-market rates

July 11, 2024 - Reps. Katie Porter (D-CA) and Rosa DeLauro (D-CT) on Wednesday introduced legislation to help prevent overcharges for prescription drugs. While insurance copays often significantly decrease the cost of a medication, it is sometimes cheaper for a patient to pay without insurance. The Lowest Price for Patients Act will set a simple standard: no patient can be charged a copay for a drug that is higher than the previous years’ national average retail price for that drug. 

“Pharmacy benefit managers are supposed to negotiate lower drug prices for Americans, but in reality they’re scamming patients with inflated costs to line their pockets,” said Rep. Porter. “Americans deserve to have confidence that they are paying the lowest price possible for prescription drugs, but too often these middlemen dupe us into paying a copay higher than the full out-of-pocket price of the medication. This is a rip-off, plain and simple. My bill would crack down on these greedy profiteers and make sure that patients aren’t paying more than the average cost of a drug.”

“No one should be charged a copay that is more than the average list price of a given drug, but unfortunately it happens all the time, due to pharmacy benefits managers (PBMs),” said Congresswoman DeLauro. “Pharmacies should be able to share price information with consumers so that they are not needlessly paying more – lining the pockets of big corporations and billionaires, especially when paying out-of-pocket for the drug would have been cheaper! The Lowest Price for Patients Act ensures that PBMs - which allegedly save consumers money in terms of drug costs – could not impose cost-sharing that exceeds its average list price. With costs on the rise and new evidence from the Federal Trade Commission that PBMs actually inflate the cost of drugs, Congress should pass this legislation to ensure Americans pay the lowest price for their prescription drugs. ”

When most patients hand over their insurance card at the pharmacy counter, they believe that the co-payment for any medication will be a fraction of the drug’s full price. But, unbeknownst to most patients, the insurance companies and pharmacy benefit managers that negotiate drug prices sometimes set copays higher than the actual cost of the drug, pocketing the difference. This leaves patients paying more than a medication actually costs. The Lowest Price for Patients Act would end this greedy practice and lower patients’ drug costs. Reps. Steve Cohen (D-TN), Raul Grijalva (D-AZ), and Ilhan Omar (D-MN) also cosponsor this legislation.

Rep. Porter has worked tirelessly in Congress to crack down on Big Pharma’s greed and lower the cost of prescription medications. Last year, Rep. Porter pressed the pharma industry about transparency in drug pricing. Her Freedom From Price Gouging Act, which was signed into law as part of the Biden Administration’s Inflation Reduction Act, has recovered billions of taxpayer dollars through prescription drug rebates, preventing manufacturers from profiting off of exorbitant price hikes. Rep. Porter has also confronted Big Pharma executives repeatedly about stock buybacks, which line the pockets of billionaires at the expense of patients.
Source: Congresswoman Katie Porter