AH081 - Promoting Competition & Innovation: The Push for PBM Reform, with Rep. Jake Auchincloss

This special episode of the Astonishing Healthcare podcast features Congressman Jake Auchincloss, who discusses his efforts to reform pharmacy benefit managers (PBMs) and address systemic issues in the U.S. healthcare system to bring down costs. Representing Massachusetts' 4th district and growing up in a family of medical professionals and scientists, Rep. Auchincloss draws on his experience to advocate for policies that promote competition, innovation, and improved access to affordable care. He highlights his Pharmacists Fight Back Act (H.R.9096), noting that he looks forward to reintroducing the widely supported, bipartisan bill that aims to protect independent pharmacies, employers, and plan members, and he shares optimism about the potential for meaningful PBM reform to become law.Auchincloss stresses the importance of challenging entrenched corporate practices to create a healthcare system that prioritizes price transparency, patients, and encourages technological innovation - such as new drug development or medical devices - in key areas affecting millions of Americans. For example, why not make curing Alzheimer's, which is expected to impact upward of 60 million people by 2025, our 'moonshot'?HighlightsMandatory NADAC reporting (cost-plus, with a fair dispensing fee) and banning spread pricing, steering, and other traditional PBM business practices will help stabilize retail pharmacies and protect payers and patients from misaligned incentives.The federal government should promote competition in areas where there's an obvious and immediate positive impact, such as the development of generic and biosimilar drugs.Improving technology for "hospital at home" and long-term care for the elderly should be a focus.Price controls won't work for drugs, and there's more work to do on price transparency for medical care.Value-based contracts make sense - GLP-1s are a good example/potential application. We should be paying for performance.Congress should promote community health centers more because "they are really meeting people where they're at with the services that they need."Related ContentThe Role of Pharmacy Benefit Managers in Prescription Drug Markets Part III: Transparency and Accountability (Rep. Auchincloss at 4:31:00)AH052 - ERISA Insights: Challenges & Compliance in Modern Healthcare, with Nick WelleRELEASE: AUCHINCLOSS INTRODUCES BIPARTISAN PHARMACISTS FIGHT BACK ACT TO CRACK DOWN ON PREDATORY DRUG PRICINGWhat is NADAC & How Does It Differ From AWP?For more information about Capital Rx and this episode, please visit Capital Rx Insights.