Mr. President, I am here today to visit with my colleagues about a group that we refer to as pharmacy benefit managers, but around Washington, the shorthand for that term is PBMs. Many Americans may not know about PBMs. They are very obscure in the whole pharmaceutical business. Yet the PBM market is nearly $500 billion, and they are powerful in our pharmaceutical drug supply chain. It is our duty in Congress to understand, first, how PBMs operate; second, hold them accountable; and, third, work to lower prescription drug costs for the taxpayers and for the consumers. In 2018, I pressed the Federal Trade Commission to investigate PBMs. I saw the ongoing consolidation in the pharmaceutical supply chain and its impact on drug prices, driving those prices up. But I didn't wait for the FTC to act. I have pursued, one, bipartisan legislation; two, held hearings; and, three, conducted oversight. Most recently, Senator Cantwell and I have introduced the PBM Transparency Act. This bill prohibits PBMs from engaging in spread pricing. This is a situation where PBMs charge an insurer more than they charge the pharmacy and then they pocket the difference. Iowans call that gaming the system. Another practice we prohibit in our bill: clawbacks. In Medicare Part D, these are sometimes called retroactive direct and indirect remuneration fees--or DIR, for short. Iowa pharmacists have told me clawbacks are costing patients more in higher copays and also costing the local pharmacy.…
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