U.S. Senator Roger Marshall, M.D. (R-Kansas), raised concerns about pharmacy benefit managers (PBMs) and prescription drug costs during a Senate Health, Education, Labor, and Pensions Committee hearing on April 16. Marshall questioned witnesses Dr. Brian Miller of Johns Hopkins University and Dr. Ryan Long of the USC Schaeffer Institute about the financial challenges facing community pharmacists and possible reforms to lower drug prices.
The discussion comes as many rural pharmacies face financial strain, with some attributing their difficulties to PBM practices that affect reimbursement rates and access to formularies. The issue is significant for communities where local pharmacists are often the last healthcare professionals available.
During the hearing, Marshall said: “In so many rural towns in Kansas, they’re the last healthcare professionals standing. And the PBMs are running them out of town, breaking them financially, oftentimes, clawing back more money than what the pharmacist is able to stock the medicine for.” He also asked Dr. Long if an audit of TRICARE’s relationship with Express Scripts would be beneficial; Long replied: “I don’t know that there can ever be a disadvantage to an audit. I think transparency is a good thing, no matter the course, no matter the event.”
Marshall also discussed drug approval processes with Dr. Miller who said: “I think the FDA has worked to accelerate the review process and make it more efficient… we could use that to restructure drug review, strengthen standards for safety and efficacy while lowering cost of market entry.” The senator highlighted concerns from pharmacists who say they must raise biosimilar prices just to gain formulary access due to rebate requirements by PBMs.
Dr. Long provided examples involving insulin products: “In order to get on formulary you must provide rebates… They actually had to launch two different products… one with a list price that was triple… in order to provide rebates.” Summing up his position on PBMs’ influence over pricing structures for drugs like biosimilars, Marshall said: “The higher cost of the drug, the more money PBM makes… That’s why we need to de link those two…”
Marshall serves on several key committees focused on agriculture; health; education; labor; pensions; finance; nutrition; forestry; and budget matters according to his official website. He chairs subcommittees related to conservation and biotechnology within agriculture as well as primary health within HELP committee work.
He practiced obstetrics and gynecology for over 25 years—delivering more than 5,000 babies—and provides services such as military academy nominations or assistance with federal agencies according to his official website. Marshall served seven years in U.S Army Reserves according to his official website, grew up as a fifth-generation farm kid in Kansas,earned degrees from Butler County Community College, Kansas State University,and University of Kansas School of Medicine becoming first in family pursuing higher education.
