By Amy Hinojosa

The high cost of prescription drugs isn't just a financial burden. It's a threat to public health. For under-served and under-resourced families, many of whom are people of color, this threat is magnified.
Healthcare policy experts at the Kaiser Family Foundation found that 61% percent of Black patients and 69% of Latinos worry about affording their prescription medications, compared to half of white adults. 
These findings provide yet more proof that America's prescription drug delivery system is broken and unjust. And a small group of powerful corporations known as pharmacy benefit managers, or PBMs, deserves the lion's share of the blame.
Lawmakers in Washington need to address their abuses by demanding greater transparency, accountability, and fairness.
PBMs don't invent life-saving medicines, nor do they prescribe them or administer them to patients. They don't pay for them, either. Rather, their job is to negotiate with drug companies to secure lower prices on behalf of the insurance firms who hire them -- the biggest three of which are locked in ownership structures with their respective PBM. Last year alone, drug companies offered $334 billion in discounts and rebates off the nominal "list" price of medicines, with most of those savings flowing through PBMs.
Unfortunately, few of those savings get passed on to patients in the form of lower out-of-pocket costs. That's because PBMs and insurers pocket the rebates and discounts for themselves -- even as they routinely charge patients coinsurance based on the list price of the drugs, not the price they actually pay drug makers. 
It's no wonder our nation's worst health inequities are getting more and more entrenched. 
PBMs, meanwhile, are getting rich. The industry has gotten so good at extracting money from the drug supply chain and driving up costs for patients that between 2012 and 2022, the three largest PBMs saw their profits more than quadruple, to $27.6 billion a year.
This kind of exploitation needs to end. And for that to happen, lawmakers in Washington will need to take action.
Fortunately, a number of bipartisan reform bills are already before Congress. One would de-link drug prices from PBM profits under the Medicare Part D program. In doing so, it would help make sure that PBMs can't boost their bottom lines by steering patients towards more expensive drugs. 
Lawmakers are also considering legislation that, among other reforms, would force PBMs and insurers to base cost-sharing on a drug's discounted price -- allowing patients to benefit from any rebates provided by drug firms.  
Both pieces of reform legislation deserve swift passage during this "lame duck" session of Congress. In the meantime, advocates will continue to educate the public about the $27.6 billion in profits our healthcare system allocates to the three largest PBMs in exchange for zero health care provided. We simply cannot allow profiteering to determine life or death for patients in need of medications.

Amy Hinojosa is the president and CEO of MANA, (Mexican American Women’s National Association) a national Latina organization, the oldest and largest Latina membership organization in the United States and founding member of the Health Equity Collaborative.