Community Oncology Alliance Pushes for Accountability, Transparency With PBMs and 340B Reform

In an interview, Nick Ferreyros, managing director of policy, advocacy, and communications at the Community Oncology Alliance (COA), discussed the Alliance’s efforts surrounding pharmacy benefit managers (PBMs) and 340B reform, both of which have been of interest in Congress.

Q: How is COA involved in the efforts for greater accountability and transparency with 340B?

Nick Ferreyros: So, COA has really been pushing the transparency and accountability issue with 340B for a long time. And one of the biggest ways we've been doing that is through original research and studies. We've put out 2 studies over the last year examining hospital markups on 340B discounted drugs, the most recent of which looked at how much hospitals mark up their drugs for commercial patients, Medicare patients, and uninsured or cash paying patients. And what we found was that for commercial or uninsured patients, it can be up to 5 times—not 5%, but 500%—for these drugs, and that is huge, especially when you have a patient who's got cost sharing and deductibles to meet. And for pricey oncology drugs, you know, where is the discount going if you're an uninsured patient and being charged 5 times for that? Especially when we see, on the other hand, these endless stories of hospitals going after patients with debt collectors.

Q: What impacts do state-level reform efforts have on Congress?

Nick Ferreyros: What people don't realize is that in Congress, only about 2% of all bills that are proposed ever make it to the finish line. In state houses that can be as high as 14% to 15%. So really, if you want to make movement on an issue that has been intransient and not really had any progress in years, states are a great place to look for that. And that's what we're seeing with some of these really difficult health care issues—in particular, PBMs. States are the true laboratory for democracy, and they've really taken the leadership role on PBM reform and transparency. We have seen it in a lot of wonderful bills in Ohio, Georgia, Virginia, Texas, I mean, you name it. I think at last count there were over 113 active PBM reform bills in the states right now. So, they have really taken the lead on this issue. And Congress is noticing as well. And you know, sometimes one leads the other, sometimes they inform each other. But, you know, as I said, this is really an area of great movement, and bipartisan movement and bipartisan energy both at the state and federal level.