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PBMs, the brokers who control drug prices, finally get Washington’s attention

Insulin and pharmacy benefit management company executives testified before the Senate Health, Education, Labor and Pensions Committee this week in Washington in preparation for a vote on PBM legislation.

By Arthur Allen | May 12, 2023 at 07:58 AM
Drug Costs (Photo: Shutterstock)

For two decades, patients and physicians eagerly awaited a lower-cost version of the world’s bestselling drug, Humira, while its maker, AbbVie, fought off potential competitors by building a wall of more than 250 patents around it.

When the first Humira biosimilar — essentially a generic version — finally hit the market in January, it came with an unpleasant surprise. The biosimilar’s maker, Amgen, launched two versions of the drug, which treats a host of conditions including rheumatoid arthritis. They were identical in every way but this: One was priced at about $1,600 for a two-week supply, 55% off Humira’s list price. But the other was priced at around $3,300, only about 5% off. And OptumRx, one of three powerhouse brokers that determine which drugs Americans get, recommended option No. 2: the more expensive version.

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