Senate hearing highlights PBM practices, patient delays and calls for transparency and fiduciary duties

At a Senate Judiciary Committee hearing on competition in the prescription drug supply chain, senators and witnesses described how pharmacy benefit managers, or PBMs, influence which drugs patients receive and how much patients and local pharmacies are paid.

Senator Chuck Grassley, chairman of the committee, opened the hearing by saying: "We're examining competition issues in the prescription drug supply chain. Pharmacy benefit managers, PBMs as we call them, play a significant role in [the] drug supply chain." He and Senator Dick Durbin, the committee's ranking member, joined witnesses in arguing that PBM consolidation, vertical integration and opaque business practices are harming patients and independent pharmacies.

The panel heard two types of firsthand accounts. Medical providers described treatment delays when PBM policies redirected specialty prescriptions away from clinicians' preferred pharmacies. "During that wait, his bowel symptoms worsened, and he desperately wondered why he had not started treatment yet. That is what we're up against," said Sheetal Kircher, a medical oncologist at Northwestern Medicine Feinberg School of Medicine, recounting a patient whose oral chemotherapy was redirected by a PBM to a different specialty pharmacy.

Independent pharmacists described financial pressures that threaten local access. Randy McDonough, co‑owner of Towncrest Pharmacy Corporation and president of the American Pharmacists Association, told senators that a medication his…