Restricting PBMs is intended to reduce prescription drug costs for New Mexicans

The unaffordable and rising cost of prescription drugs is an issue that is frequently brought to my attention by my constituents. As a former single mother who raised two children, I understand the struggle of balancing a tight budget with healthcare costs.

When I was sworn in as a representative in 2017, I immediately went to work introducing a bill to address high drug costs. Although we faced opposition and a veto from then-Governor Martinez, it only strengthened our resolve to tackle this problem head-on.

After years of work and various proposals, there is finally a movement to target the player most responsible for the ever-increasing cost of prescription drugs: Pharmacy Benefit Managers (PBMs). Originally operating as claims adjusters, these companies have evolved into powerful forces that control everything from the drugs patients can access to the amount they pay at the pharmacy checkout. Currently, three PBMs control about 80% of the market, giving them unprecedented control over drug listing decisions and patient costs.

PBMs' profits have exploded from $6.3 billion in 2012 to $27.6 billion in 2022. At the same time, patient out-of-pocket costs for brand-name drugs have increased 50% between 2014 and 2022. Americans are footing the bill for PBMs' rising profits.

One problem is how PBMs handle manufacturer discounts and rebates. While PBMs negotiate significant price reductions with drug manufacturers, these savings often do not translate into lower costs for patients. In fact, PBMs often calculate patient copayments and other out-of-pocket costs based on the non-discounted price of a drug.