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Georgia Lawmakers: Don’t Miss Your Chance to Hold Pharmacy Middlemen Accountable

Georgia patients are facing an uphill battle with skyrocketing prescription drug costs. For many, particularly those with chronic health conditions, the struggle to afford medications has become a daily reality. But there’s another layer to this issue: pharmacy benefit managers (PBMs), a growing industry of insurance middlemen, are making things worse. These PBMs are driving up healthcare costs, restricting access to critical medications, and profiting off of patients’ suffering. It’s time Georgia lawmakers took action to rein in PBMs and prioritize patient care.

The Hidden Role of Pharmacy Benefit Managers

PBMs, hired by health insurers, are supposed to help negotiate drug prices with pharmaceutical manufacturers to reduce costs for patients. But in practice, they’ve become one of the most powerful players in the healthcare system. PBMs wield significant control over which treatments patients can access and how much they’ll pay for them. These middlemen operate with very little transparency, making decisions based on what’s most profitable for the insurance companies they work for—not on what’s best for patients.

The problem is compounded by the fact that PBMs pocket rebates and discounts from drug manufacturers, but often fail to pass these savings on to the patients who need them. Instead, the costs are passed on to the consumer, who pays more at the pharmacy counter. This creates a situation where PBMs are making millions, while patients are left with crushing out-of-pocket expenses.

A Personal Perspective: Why Reform is Critical

As someone who has lived with multiple chronic conditions—cancer, arthritis, and lupus—I know firsthand the dangers of being unable to access the necessary treatments. As a nurse, I’ve also seen the devastating consequences when patients can’t afford their medications. PBM reform is not just a political issue; it’s a matter of life and death for many Georgians.

Georgia pharmacy middlemen reform

In other states, there have already been significant strides. Arkansas passed a law requiring PBMs to pass 100% of manufacturer rebates directly to patients at the point of sale. Other states like West Virginia and Florida are taking similar steps to ensure PBMs are more transparent and that savings are passed on to the people who need them most. Georgia should be next.

The High Cost of Inaction

Access to affordable healthcare is a basic right for Georgia residents, but rising prescription drug prices are making it increasingly difficult for many to maintain their health. In fact, almost 70% of Georgians reported experiencing a healthcare affordability burden in 2021. Nearly 40% said they’d cut their pills in half, skipped doses, or gone without medications altogether to try to manage high costs. This creates a vicious cycle where untreated health conditions lead to even higher medical costs down the line, including hospitalizations and emergency room visits.

When patients can’t afford the care they need, their health worsens. Chronic conditions such as hypertension, arthritis, and cardiovascular disease require ongoing treatment to manage symptoms and improve quality of life. If patients are forced to skip treatments due to high costs, their health outcomes can deteriorate, which in turn leads to even higher healthcare costs.

States Leading the Way on PBM Reform

Federal and state officials across the country are finally starting to take a closer look at PBMs and their predatory practices. Last year, after a two-year investigation, the Federal Trade Commission (FTC) found that PBM integration with pharmacies and insurers had allowed these middlemen to dominate the healthcare system. The FTC even filed a lawsuit against three of the nation’s largest PBMs, accusing them of anticompetitive behavior that restricts access to care.

Meanwhile, a New York Times report revealed that PBMs often steer patients toward more expensive medications, knowing they’ll make a larger profit. These practices are raising alarm bells across the nation.

Georgia lawmakers have a responsibility to address this issue before it causes even more harm. A recent attempt to pass legislation requiring PBMs to share negotiated savings with patients failed in the last legislative session. This setback was a missed opportunity to provide immediate relief to patients struggling with high drug costs.

Time for Action: What Georgia Needs

Georgia lawmakers must act in the upcoming session to implement reforms that prioritize patient well-being over PBM profits. Policies that increase PBM transparency and accountability—such as requiring them to pass manufacturer savings directly to patients—are commonsense solutions that would bring relief to Georgians suffering from high healthcare costs.

Federal representatives like Congressman Buddy Carter have been vocal advocates for PBM reform, and others like Congressman Jake Auchincloss are pushing for action on inflated drug costs. It’s time for Georgia’s state lawmakers to do the same. Implementing measures that hold PBMs accountable and ensure they don’t profit at the expense of patients should be a top priority when the legislature reconvenes.

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