Former Gov. Howard Dean has been a longtime advocate for access to health care and should be recognized for his years of public service. Unfortunately, his recent op-ed (“Time to crack down on middlemen that inflate costs of drugs like insulin,” April 18) grossly misses the mark on the role pharmacy benefit managers, or PBMs, play when it comes to insulin.
Drug manufacturers have leveraged limited competition in the insulin market to increase the list price of insulin products over the past 10 years. PBMs, on the other hand, are working on behalf of patients to negotiate lower costs and increase access to these needed medications. PBMs have stepped up efforts to help patients living with diabetes afford their medications by introducing new programs to cap, or outright eliminate, out-of-pocket costs on insulin. In addition, PBMs are providing patients with clinical support and education that result in better insulin adherence and health outcomes.
A recent analysis published by pharmacy consulting firm Visante, “Insulins: Managing Costs with Increasing Manufacturer Prices,” shows that PBMs have held net insulin costs flat. The same analysis outlines how insulin list prices, set solely by drug manufacturers, have escalated over the past decade. Clearly, more needs to be done, and the introduction and adoption of biosimilar insulins and greater competition will be an important element moving forward. PBMs will continue to focus on finding cost-effective, care-oriented solutions for patients living with diabetes and others who rely on prescription drugs.
All of us who seek greater access and affordability for patients should remember that drug manufacturers alone set and raise prices on insulin.
— J.C. Scott, president and CEO, Pharmaceutical Care Management Association, Washington
Pharmacy benefit managers’ power
Thank you, Dr. Howard Dean, for calling out pharmacy benefit managers, or PBMs, for their bilking of the U.S. health system. I’m curious, however, why someone of stature is speaking out only now, since this practice has been ongoing for decades. Pharmacists know the deleterious effects these organizations have had on the pharmacy profession and the billions of dollars leached from the system. This money has bought PBMs legislative protection, which I hope will be coming to an end.
The end will be messy because of the relationship between PBMs and some of our largest insurance companies. Cigna owns Express Scripts, CVS Health owns Aetna, UnitedHealth Group owns Optium Rx and Blue Cross Blue Shield has an ownership interest in Prime Therapeutics. These companies control a large portion of the health care marketplace and prescription sector.
Dean’s op-ed touched only the tip of the iceberg concerning the money lost to PBMS. It is time for their demise.
— Thomas Gochenour, pharmacist, Riverside
Human right to mental health
When I was 12, one of my classmates ended his life because he was overwhelmed with school. At the time, I was young and did not understand the severity of the situation, but as I grew older, I came to realize that my classmate would still be with us if my school had proper resources for children struggling with their mental health.
As I completed my middle and high school years and reached college, I have seen the mental health crisis get worse and worse. As a society, we need to prioritize mental health, especially that of children.
Like my classmate and many people around me, there are millions of children around the world in desperate need of mental and psychosocial support. Almost 452 million children live in areas affected by armed conflict, which has led to more than 14% of children worldwide having a mental health disorder. Consider the children in Ukraine who are living through or have fled war and desperately need help coping with their trauma.
I’m a college student majoring in political science and psychology, and I know the important role mental health plays in a child’s healthy growth, development and future success. That is why I support the Mental Health in International Development and Humanitarian Settings, or MINDS, Act. This first-of-its-kind act would promote mental health and psychosocial support as an integral part of U.S. foreign assistance.
In May, Mental Health Awareness Month, join me and Save the Children Action Network in urging members of Congress to support this bipartisan legislation. The futures of millions of children are at risk, and by investing in their mental and psychosocial well-being, we are investing in the brighter future and long-term success of our global community.
— Lavannya Deolalikar, Aurora
Join the conversation in our Letters to the Editor Facebook group.
Submit a letter, of no more than 400 words, to the editor here or email letters@chicagotribune.com.
