Providing financial relief to cancer patients in Colorado who are struggling to afford their expensive, life-saving medications is a top priority for policymakers across the political spectrum. An important step to enacting substantial cost savings is to reform the anti-patient practices of companies that exert huge control over the prescription drug marketplace. A bipartisan group of U.S. senators is aiming to do just that.

Put yourself in the place of a cancer patient in the throes of treatment. In addition to the huge physical and mental burden on patients, their families and caregivers, there can be an immense financial strain when out-of-pocket costs can average $10,000 or more per year.

At ICAN, International Cancer Advocacy Network, we hear about these struggles daily, and we are increasingly focusing our attention on the role played by Pharmacy Benefit Managers (PBMs). Few patients are aware of how these large corporate entities create needlessly high drug costs.

PBMs dominate the pharmaceutical supply chain, and just three PBMs control more than 80% of the market. They determine what insurance plans pay for drugs, develop drug formularies that tell patients what drugs are available to them under their insurance plans, and they set out-of-pocket costs. Most significantly, PBMs negotiate often generous rebates from the manufacturing companies that reduce what the insurance companies have to pay for prescription drugs.

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These rebates, however, are rarely passed along to consumers – and this means big bucks for insurers. Though insurers pay less, patients pay more.

The U.S. Senate is putting a spotlight on several anti-patient practices that reduce the affordability and accessibility of medications. We are very hopeful that Sen. John Hickenlooper, who has been a strong supporter of patient rights as a senator, just as he was as governor, will be a vocal supporter of S. 127, the Pharmacy Benefit Manager Transparency Act. This is bipartisan legislation sponsored by Maria Cantwell of Washington, the Democratic chair of the Commerce, Science, and Transportation Committee, and the committee’s top Republican, Chuck Grassley of Iowa.

What does this bill do?

First it targets the anti-consumer practice of “spread pricing,” which occurs when PBMs bill employers or health plans a higher amount than what they ultimately pay to pharmacies. The PBMs then pocket the profit, which can mean higher premiums for patients. In fact, spread pricing has been shown to increase costs to Medicare by $1 billion or more.

Of equal concern to patients, particularly those in rural areas of Colorado, is the pressure PBMs put on locally owned community pharmacies, which can be the only pharmacy available for miles around. For example, PBMs can decide to reimburse a local pharmacy for medication at a rate less than what the pharmacy paid for it – a big financial hit for small retail businesses. PBMs also engage in “clawbacks” of payments already made to pharmacies, another hit to their bottom line.

Having a close relationship with local pharmacies – and pharmacists – is a high priority for cancer patients. Medications, and their dosages, often need to be altered during treatment, and being able to have a known and trusted partner at the local pharmacy makes this difficult journey a little easier.

More and more, however, we are learning PBMs are providing incentives for patients to do business with pharmacies that PBMs own or invest in – including online mail-only pharmacies. The potential cost difference is such that patients have no choice but to switch, even if it is against their will and better judgment.

That the U.S. Senate is shining a bright spotlight on the anti-consumer practices of PBMs and the effect these big companies have on drug costs – and on patients’ pocketbooks – is great news. We strongly support this common-sense cost transparency legislation because it offers great benefits to patients in every corner of Colorado.

Peggy Dennis, a resident of Denver, is a member of the Exon 20 Group Council at the International Cancer Advocacy Network. ICAN, founded in 1996, is a nonprofit organization that connects late-stage cancer patients to clinical trials and other cutting-edge treatments.