I am a resident of Plymouth living with psoriasis and psoriatic arthritis. These chronic autoimmune diseases demand constant management, including biologic injection treatments that keep my symptoms in check and help me live a productive life. Unfortunately, instead of focusing on my health, I often find myself battling a faceless middleman: the pharmacy benefit manager (PBM).
PBMs hold significant power in determining which medications are accessible to patients and under what conditions. Their practices, such as requiring onerous prior authorizations and instituting fail-first policies (also called step therapy), have caused me significant delays in receiving my treatments. These bureaucratic hurdles mean that instead of quickly accessing the medication prescribed by my doctor, I am forced to “try and fail” with less effective treatments before my insurance covers what works for me.
This not only prolongs my suffering but also risks worsening my condition. Flare-ups caused by treatment delays impact my ability to work and my overall quality of life on a day-to-day basis. These disruptions are avoidable, yet they persist because PBMs prioritize cost-saving measures over patient well-being. This issue isn’t limited to me. I’ve spoken to numerous patients in Plymouth and around the state, living with varying conditions, who have encountered similar obstacles. When a person cannot access the care or treatments they need, the effects can be far-reaching, from their family to their employer. Moreover, medication adherence problems lead to higher healthcare costs in the long run.
Bipartisan support exists for PBM reform at the state and federal levels. We came close to passing significant reforms last year, but unfortunately, we’re still pushing for change. Patients cannot afford further delays. Patients still face high prescription drug costs, while PBMs profit from hidden fees and unclear pricing practices. Lawmakers can directly impact patients by delinking PBM profits from drug prices. This practice allows PBMs to prioritize more expensive drugs despite the availability of more inexpensive and effective options. Policies requiring PBMs to share negotiated rebates with patients would reduce prescription costs and benefit patients financially. These proposals increase transparency, prevent PBMs from utilizing exploitative pricing tactics, and limit policies that delay or deny access to prescribed medications.
Decisions about treatment should rest solely between a patient and their doctor, not a profit-driven middleman. My doctor knows my medical history, the severity of my symptoms, and what treatments will work. PBMs, on the other hand, operate with opaque practices that prioritize their bottom line over the needs of people like me.
This issue is not unique to psoriasis or psoriatic arthritis. Millions of Americans and thousands of Plymouth residents with chronic conditions – ranging from diabetes to cancer – are trapped in the same exhausting cycle of delays, denials, and appeals. These bills represent a rare opportunity for bipartisan action to ensure patients have access to timely, affordable care.
– Jody Quinn
Jody Quinn is a Plymouth resident and patient advocate for psoriatic disease and other chronic illnesses. She works with several organizations to raise awareness of patient issues.