Dear Colleague,
My friend John Vinson, the state executive of the Arkansas Pharmacists Association, recently sent me an article from the Arkansas Democrat-Gazette reporting that nearly half of the record $1.6 million spent this year on lobbying in the state was on opposition to the state's bill prohibiting owning both a PBM and pharmacy. The last time so much money was spent was 2009, when the big spender was the company Altria, which was also trying to get a bill killed. Also unsuccessful. Big tobacco. Big PBMs. They seem to have a lot in common.
Sixteen years ago, the corporate jets flying into Little Rock spent around $330,000 to stop an increase in tobacco taxes that would help fund health-related programs. Fast forward to 2025, and the PBM shill, Conservatives for Lower Health Care Costs, spent more than twice that amount (plus who knows how much in corporate jet fuel!) to try to stop the Arkansas legislature and Gov. Sarah Huckabee Sanders from passing and signing HB 1150. Just like big tobacco from 15-20 years ago, the PBMs seem to have a playbook they use repeatedly to try to kill legislation threatening their anticompetitive oligopoly.
Predictions of Cost Armageddon—The PBMs No. 1 go-to move is almost always predictions that health care costs will skyrocket if legislation that holds them accountable is passed. For some unknown reason, this used to actually work in some states but, like the boy who cried wolf, some courageous states saw through the rhetoric and passed PBM legislation anyway. Guess what? Prices didn't go up. In fact, in most cases health care costs actually went down!
Taking Their Ball and Going Home—Like the good sports they are, the mega-PBMs love to threaten to leave a state, and patients will be left stranded without insurance coverage. Really? To the best of my knowledge, this threat has been made dozens of times and has actually happened zero times. I'd love to see the shareholder reaction to a company that exits a still very profitable business out of spite. I'm guessing it would not be a good thing for the C-suites' stock options or multi-million-dollar bonuses.
Right Wing Rally—The PBMs hope that right wing conservatives will come to their rescue, so they have enlisted a few to be their pawns. Former Secretary of State Mike Pompeo has been one. Another one of their favorites has been former Sen. Pat Toomey. "Stop the Left's Socialist Health Care Takeover" is the screaming headline on the splash page of Conservatives for Lower Healthcare Costs. Surely it's the first time that Sarah Huckabee Sanders has ever been painted as a Bernie Sanders socialist!
Tobacco use has come a long way, baby. Adult tobacco use is down to 11 percent—an all-time low—but it's still the number one cause of preventable deaths in the U.S. Unfortunately, PBM use is still high and contributing to higher costs and impacting health outcomes. The dark comedy movie "Thank You for Smoking" is about the spin the tobacco industry would put on something so clearly bad for public health to confuse the issue or dodge the main points. That spin lasted a long time—the surgeon general's warning on cigarettes started in 1965. At NCPA we're working to help people see through the PBMs' spin. The FTC, House Oversight Committee, multiple congressional hearings, investigative articles in the New York Times, Wall Street Journal, and the Modern Medical Mafia docuseries have all called out the economic and health care dangers of PBMs.
Our advice for employers and government continuing to hire mega-PBMs is the same advice for smokers: "Quit. Before it's too late."
Best,
B. Douglas Hoey, Pharmacist, MBA
NCPA CEO
PS: Late yesterday, the Louisiana Senate passed an aggressive PBM reform bill that bans all fees charged to pharmacists, bans spread pricing, prohibits PBMs from retaining rebates, and a lot more. HB 264, sponsored by Rep. Michael Echols, now heads to Gov. Jeff Landry for his signature. By the way, Landry was on fire yesterday. CVS sent a mass text message to its customers urging them to oppose an ownership bill, HB 358 by Rep. Dustin Miller. This bill is similar to what Arkansas recently passed. Using private patient data to agitate against reform appears to be a big no-no. Landry called on Attorney General Liz Murrill to open an investigation, which she did immediately. Stay tuned to qAM and @commpharmacy for more details.
