PBM reform needed

Trudy Caviness

Ottumwa

Health insurance is a key line item for any business owner. My husband and I owned our small business for 44 year. For myself and so many others, we have seen healthcare costs continue to rise while patients’ options continue to decline. In trying to understand more about why this is happening, I’ve learned about pharmacy benefit managers.

PBMs were created to help insurance plans manage their prescription drug benefits. Essentially, they are the middlemen. But over the years, their lack of regulation means they have been allowed to spiral out of control. Three companies now control nearly 80% of prescription drug benefits nationwide. With unchecked power, PBMs are unnecessarily increasing prescription costs and forcing patients to use only the drugs and pharmacies that PBMs approve.

These exorbitant costs and strict guardrails are reflected in insurance plans, but they are having a devastating effect on Iowa pharmacies.

In 2024, 29 Iowa pharmacies had to close, including four in southern Iowa. PBMs are the culprit.Our pharmacies should not have to endure financial strain due to the outsized influence of a profit-hogging middleman.

Thankfully, Iowa legislators have introduced HF 852 and SF 383 to clamp down on PBMs’ unjust practices. I encourage our lawmakers to consider the economic and personal impact that PBMS have on pharmacies big and small across our great state. A recent poll shows Iowans support their local pharmacy and want to see reform pass – with more than two-thirds of voters saying the state legislature should consider PBM reform to be ‘must pass legislation’ this year. Opponents to PBM reform say premiums will rise as a result. The results in other states who have passed this legislation proves these claims completely untrue.

These pharmacies play vital roles in urban and rural communities and without them, their patients will soon live in pharmacy deserts.