The Health Care Agenda 2024: As a pharmacist, Rep. Harshbarger seeks to improve prescription drug access

As someone who has a been a licensed pharmacist and business owner for nearly four decades, Rep. Diana Harshbarger (R-TN) has a unique perspective on rising drug prices.

Like many members of Congress, she is concerned about how the increasing costs of prescription drugs are affecting her constituents. In fact, she shared during WTOP’s The Health Care Agenda 2024 that the changes she’s seen in the pharmacy industry led her to run for Congress.

Not that long ago, she noted filling a prescription and addressing a fee for service was as simple as using a credit card machine, getting forms in triplicate and sending in two copies.

Now, it is much more complicated.

Harshbarger said she has always sought to help the patient, providing an alternative medicine if the one they originally sought wasn’t covered by insurance.

“I feel like the pharmacist does triage,” she said. “You have the physician or the healthcare provider, the patient and the pharmacist. It’s my job to send them in the best direction, to get the best healthcare that they can get.”

She is co-sponsor of the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include services provided by a pharmacist.

Supporters of the legislation point to areas of the country that are underserved by doctors and rely heavily on local pharmacists.

Concern about rising costs and the “middleman”

Members of both parties in Congress have been increasing scrutiny of pharmacy benefit managers (PBMs). “The cost of medications have skyrocketed and now we have a middleman,” Harshbarger said of the PBMs.

Some PBMs are transparent in how they deal with getting prescription drugs from drug companies to patients, she acknowledged. But many others are not and critics like Harshbarger point to PBM rebates for pharmaceutical companies.

The patient often has no idea what the rebate is or what it could mean for their co-payment, she pointed out.

Harshbarger also noted that she has seen plans that change early in the year and then patients find out that the drugs they thought were covered by insurance are no longer covered or their co-payments are higher.

“That’s where there’s no transparency,” she said. “There’s no transparency about what the rebate system is … and we’ve got to put an end to that.”

PBM advocates have rejected the criticism, arguing that they are an important part of the health care system that ultimately helps get prescription drugs to the people who need them.

But several bills aimed at PBM reform are now before Congress, as lawmakers begin a new year. PBM legislation was ultimately dropped by House Republicans from a scaled-back spending bill in December.

Harshbarger said she remains hopeful her legislation will stay on the political radar in 2025, noting that the new Senate Majority Leader John Thune(R-SD) has been a supporter.

“I want to push it as hard as I can because these independent pharmacies and these little patients deserve to know what they’re paying, and they need to be able to survive,” Harshbarger says.

Discover more articles and videos now on WTOP’s The Health Care Agenda: Real Policies for Real People event page.

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