PBMs a big topic in insurance hearings

Lawmakers hone in on PBM problems. More good news about vaccines. (890 words, 4 minutes, 27 seconds)

Lawmakers highlight PBM abuses as they grill insurance CEOs

While they differed on root causes for high health care costs, Republican and Democrat lawmakers questioning insurance CEOs last week agreed that insurer integration with pharmacy benefit managers (PBMs) drives up premiums and prior authorization hurts patients.

The hearings:The House Ways & Means and Energy & Commerce committees held separate Jan. 22 hearings to question the five CEOs of UnitedHealth Group, CVS Health, Elevance Health, and Cigna Group about high premiums.

Why it matters: Insurers are vertically integrated with PBMs, middlemen who operate opaquely and take rebates and fees, using their market concentration to increase their profits by driving up drug prices while restricting patient access to medicines.

Vertical integration of insurers owning PBMs: In E&C, Chair Brett Guthrie (R-KY) and Rep. Lori Trahan (D-MA)  asked how insurers can claim their market is competitive when they own PBMs and pharmacies. In the W&M hearing, Rep. Greg Murphy, MD (R-NC) called vertical integration “disastrous and criminal.”

PBMs retaining drug maker’s rebates: In E&C, Rep. Miller-Meeks (R-IA) asked what percentage of manufacturer rebates and fees negotiated by your PBM are retained. In the W&M hearing, Rep. Claudia Tenney (R-NY) asked if rebates obtained by United Health Care’s PBM OptumRx are held by the corporation.

Prior authorization preventing access: Insurers pledged prior authorization improvements under questioning by Rep. Miller (R-OH) in W&M and others. In E&C, Rep. Kim Schrier (D-WA) and Rep. Gus Bilirakis (R-FL) urged reform and Rep. Earl (Buddy) Carter (R-GA) asked an insurer if he’s ever “looked a patient in the eye” when denying a treatment.

What’s next: Chairs Guthrie and Smith have promised further hearings on the cost of health care.

Good news: Studies show why we should support vaccine research

New reports about positive data from a cancer vaccine and further benefits from the shingles vaccine provide more reasons why supporting vaccines and research into their development makes sense.

Cancer vaccine data: After 39 months, a Phase 2b clinical trial of patients with high-risk stage III/IV Melanoma showed “mRNA-4157 (V940) in combination with KEYTRUDA reduced the risk of recurrence or death by 49% and the risk of distant metastasis or death by 62% compared to KEYTRUDA alone,” according to Merck.

Why it matters: mRNA COVID vaccines saved millions of lives and were recently shown to have a possible anti-cancer benefit. Clinical trials are testing mRNA vaccines against cancer of the skin, lung, breast, prostate, pancreas, and brain. Yet federal research into mRNA vaccines is being wound down.

BIO’s view: “Biopreparedness through investment in research of innovative biotechnology platforms, like mRNA, is vital to maintain the flexibility, capacity and the self-determination of defending our nation,” BIO says. “Retraction of investment in one area of research for this platform could erode progress and discourage investment in other promising areas of research.”

Shingles vaccine studies: Shingles vaccines apparently slow aging by reducing inflammation and slowing epigenetic and transcriptomic aging, says a Jan. 20 study. Meanwhile experiments in Canada, detailed in the February edition of the Lancet gave further support to a previous study showing the shingles vaccine helps stave off dementia.

This is why BIO supports vaccination: “Decades ago, diseases like polio and measles brought suffering and death with no defense. Today, immunization represents the right and the ability to defend and protect those we love,” says BIO’s campaign, “Invest in America. Vaccinate.”

What Else to Read

ACIP Chair says polio and measles vaccines for children should be optional. The vaccines should only be offered to children after consultation with a physician, said Kirk Milhoan, MD, chair of the Center for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP). Speaking on a podcast last week, Milhoan acknowledged “concerns” that unvaccinated children could die of measles or be paralyzed with polio but maintained parents should have “freedom of choice.” Criticism was widespread, including from Sean O’Leary MD of the American Academy of Pediatrics who said Milhoan espoused “an ideological agenda not grounded in science.” Read more here.

House Judiciary Committee released a report showing CVS Health is "stifling innovation by threatening independent pharmacies." The Committee announced Jan. 21: "According to documents produced to the Committee, CVS Health developed a plan to invest heavily in the digital pharmacy sector. CVS Health saw online pharmacy services as the future and feared falling behind if it did not develop its own hub pharmacy to compete against innovative companies. After surveilling rival hubs and investigating independent pharmacies that work with those hubs, instead of vigorously competing, CVS Health took action to foreclose competitor access to independent pharmacies." Read more here.

BIO joins high-level PAHPA panel. Phyllis Arthur, BIO Executive Vice President and Head of Healthcare Policy and Programs, speaks on Capitol Hill during the Jan. 21 panel, “PAHPA Turns 20: Reauthorizing Readiness for Domestic Health Security Threats,” hosted by Johns Hopkins Center for Health Security. Arthur explained that preparedness is not static and legislation reauthorizing the Pandemic All Hazards Preparedness Act (PAHPA) is critical to sustaining the public-private partnerships authorities need for U.S. biodefense readiness. She called industry's role in this partnership essential to achieving the goals of American national security and preparedness.

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