Democratic senator calls on HHS to investigate PBMs blocking access to generic cancer drug

Sen. Jacky Rosen (D-Nev.) wants the Department of Health and Human Services (HHS) to investigate why a low-cost generic cancer drug isn’t widely available to patients. 

In a letter sent to HHS Tuesday shared first with The Hill, Rosen questioned why Medicare patients pay $3,000 a month for abiraterone, a generic oral drug used as part of prostate cancer treatment, when a version that costs $171 is also on the market. 

The drug is sold by CivicaScript, a nonprofit that works with manufacturers to develop a drug and then partners with insurers, pharmacies and pharmacy benefit managers (PBMs) to sell it to patients at a fraction of the price it would cost otherwise. 

The cost of the drug from Civica is $160, with a suggested final price to the consumer of $171. But the drug is only available to a limited number of patients, according to Rosen and Civica.

Rosen asked HHS to investigate and identify the “market barriers” preventing widespread access to abiraterone, as well other low-cost drugs being blocked from patient access. 

Abiraterone is considered a “specialty drug,” meaning only specialty pharmacies can dispense it. Many PBMs run their own specialty pharmacies and earn money from dispensing expensive drugs, so there’s a financial incentive for them not to participate with Civica.  

Only one the three largest PBM-owned specialty pharmacies have purchased or dispensed Civica’s version of abiraterone, and only in small quantities, according to Civica. 

“A cancer diagnosis is already difficult enough for patients to navigate with the best of care, but it is unacceptable for an approved low-cost treatment to be limited to the point that patients cannot easily access the treatment or the benefit from the cost savings,” Rosen wrote.  

“Patients should now be seeing a drastic reduction in cost for abiraterone due to Civica’s lower price structure, and it is unacceptable that the cost for cancer patients to access this life-saving prescription drug has remained unreasonably high due to barriers preventing Civica’s drug from being widely available,” Rosen added.