A new political ad warns North Carolinians about a bill that could tighten regulation of the healthcare industry. But the ad overstates the bill’s expected impact and omits key details that could give voters a different impression of the bill.
The narrator of the ad said:
“This is a warning to conservative voters. Bernie Sanders is trying again, this time with a drastic plan to tighten government control over pharmacy benefits.
“Worse? Some Republicans support it.
“Sanders’ socialist plan is not just an attack on the nation’s health care benefits, it is his next step toward government-run health care, smashing pharmacy benefits, increasing drug prices, and replacing private health insurance. It’s threatening.
“Call Ted Budd and tell him to speak out against Bernie’s radical medical hijack.”
If enacted, the bill would increase government oversight of pharmacy benefit managers. But medical analysts say the ad grossly overstates the bill’s potential impact on both consumers and the healthcare industry.
“This ad seemed incredibly over-made to me,” said Matthew Fiedler, a senior fellow at the Brookings-Schaeffer Health Policy Initiative. “Regardless of the merits of these proposals, this is not a fundamental change in U.S. health care policy.”
Tom Schatz, president of the group that paid for the ad, defended the ad in a statement to Politifact. Schatz said Sanders is “again leading an attack on private health care to achieve his self-proclaimed goal of nationalizing health care.” “Conservative lawmakers should not support bills that seek to strengthen government oversight of health care, especially bills that increase patient costs and reduce options for small businesses.”
About invoices
A pharmacy benefit manager (PBM) is a third-party intermediary that manages prescription drug benefits for health insurance companies and Medicare Part D drug plans. These can impact consumer costs as they help insurers decide which prescriptions to cover (or which prescriptions to consider in their network). We also negotiate prices with pharmaceutical companies and work directly with individual pharmacies on pricing.
PBMs often receive rebates calculated as a percentage of the manufacturer’s list price. Therefore, the Commonwealth Fund argued that these administrators received more rebates on expensive drugs than drugs that cost less and potentially offer better value.
Fiedler said the bill has four main purposes.
- Increase transparency in the decisions and operations of pharmacy benefits managers.
- Require PBMs to pass on all rebates they receive from pharmaceutical companies to their employers.
- Prohibits “price spreads,” in which PBM charges insurance plans for prescription drugs at a price that exceeds the price paid to the pharmacy for the drug.
- Requires PBMs to have a process for granting exceptions for “phase therapy,” which requires that plans try patients on cheaper drugs for their disease before covering more expensive drugs.
This bill is far from bringing about the sweeping changes advertised suggest,” said Joshua Cohen, an independent healthcare analyst. He said the PBM reform “has nothing to do with government-run health care.”
Cohen said in an email. “The government has long worked to regulate insurance under both Democratic and Republican administrations, and in all 50 states. You will lose your protection and be at a disadvantage.”
“Unless you take the extreme liberal view that there is no place for government anywhere in health care or the economy, it is very normal for federal and state governments to intervene on behalf of voters,” he said.
the effect of the bill
Experts told Politifact that it was difficult to predict the impact of the bill on drug prices and the public health care system. As for Mr. Sanders’ bill, he said he didn’t expect a dramatic change in consumer plans. But different parts of the bill can cause different ramifications. There will be good influences and there will be bad influences.
Fiedler and Cohen, meanwhile, said they can expect the bill’s instructions on rebates to have little or no effect on costs. In many cases, the PBM has already passed the rebate on to the employer.
“If PBM is required to pass (all) rebates to employers, PBM is likely to respond by demanding a higher rate for services to the plan,” Fiedler said. “So if the goal is to cut costs for employers, this doesn’t seem like a particularly effective policy change. But mechanically, that’s what[the proponents]are trying to achieve.”
Cohen, an independent analyst, speculated that the directive could lead to higher premiums.
“If rebates are removed from the plan as a result of this bill, PBM could effectively increase premiums, such as Medicare Part D benefits, as an unintended consequence,” he said in an email. Stated, outpatient benefits.
“Historically, rebates have likely dampened Part D premiums,” Cohen told Politfact in an email, highlighting the paucity of empirical evidence. “Subject to change by enactment of law.”
“It’s plausible that the spread pricing ban would increase net costs, but I doubt the increase would be significant,” Fiedler said. “In any case, it is difficult to see how such arguments over the minutiae of spread pricing can substantiate the broader claims of advertising.”
our judgment
The ad said Sanders’ bill would “strengthen government control” over pharmacy benefits and be a “fundamental medical takeover.”
The bill, which has bipartisan support, would introduce new regulations for pharmacy benefit managers. Some experts say the regulation could affect the health insurance plans of Americans by changing the types of prescription drugs covered by insurance plans and how much they pay. there is
But the ad overstates the bill’s potential impact and is far from a “medical takeover.”
This ad contains elements of truth but ignores important facts that give a different impression. We rate it “almost wrong”.
