Last Tuesday, US Sen. Bernie Sanders, chairman of the Committee on Health, Education, Labor, and Pensions (HELP), held another hearing on one of his favorite topics: the high cost of drugs, especially Ozempic (for diabetes) and Wegovy (for weight loss). To appear before the committee, the liberal firebrand called Lars Jorgensen, chairman of Novo Nordisk, maker of the two drugs, which is based here in North Carolina.

Sanders hoped to put Jorgensen on the spot. He quoted the price of Ozempic ($59 in Germany, $122 in Denmark, $155 in Canada, and $969 in the United States) and Wegovy ($92 in the United Kingdom, $140 in Germany, $186 in Denmark, and $1349 in the U.S).

“You’re charging us far more,” Sanders contended. “And you haven’t given me an answer as to why.”

Actually, Jorgensen had explained why. The reason isn’t complicated. In the United States, 75% of the cost of Ozempic and Wegovy goes to pharmaceutical business managers (PBMs). PBMs do not exist outside the United States, which is why drug costs are dramatically lower in other countries.

What is a PBM? A company that negotiates drug prices for an insurance company, in effect a middleman. PBMs emerged in the marketplace in recent years because Obamacare placed a cap on the amount of profit an insurance company can make. PBMs are owned (and often created) by insurance companies because they have no cap on profits. PBMs routinely demand sizable “rebates” from drug companies (essentially kickbacks) for their drugs to be sold.

In August, Vice President Kamala Harris spoke out against PBMs, declaring that as president she will “demand transparency from the middlemen who operate between Big Pharma and the insurance companies, who use opaque practices to raise your drug prices and profit off your need for medicine.” No doubt her focus will be on the three largest PBMs — Caremark (owned by CVS Healthcare), Express Scripts (owned by Cigna Group) and Optum Rx (owned by UnitedHealth Group) — which control 80% of the American prescription market. 

Even so, Sanders remains convinced the problem is not PBMs. Indeed, he is directly negotiating with PBMs on the price of Ozempic and Wegovy, justifying doing so by arguing “at the end of the day…Novo Nordisk is still charging us substantially many times more than they are charging other countries.” Sanders doesn’t accept the fact that 75% of the cost of Ozempic and Wegovy is going to PBMs, which provide no added value to the process.

Sanders’s colleagues do understand the problem. US Sen. Roger Marshall, a Republican from Kansas, said: “Novo Nordisk is not the villain in this story. They’re a hero. The PBMs are making the bank here.” Senator Tim Kaine, a Democrat, added: “We’re letting PBMs get away scot-free. Color me skeptical that they’re going to come to the table and suddenly have a conversion experience and start doing the right thing.”

Still, Sanders seems determined to maintain his posture — of blaming drug companies while excusing PBMs — so much so he has partnered with politicians who share his thinking on drug costs if not his politics, like Dale Folwell, North Carolina state treasurer. At a pre-hearing forum, Sanders hosted the conservative Republican, who believes covering weight-loss drugs at current prices will bankrupt North Carolina’s healthcare plan.

Folwell is right that these weight-loss drugs strain budgets at the current price. But the sky-high prices are due to PBMs not drug companies.

What is Sanders solution to high drug costs? “[G]overnment price controls and the redistribution of privately owned intellectual property through compulsory licensure,” according to North Carolina’s Speaker of the House Tim Moore in a letter responding to Folwell. It’s a plan that’s destined to end in disaster.

Instead, Sanders should address the real problem and pursue the obvious solution: PBM reform. Such a bill has already passed the Senate HELP committee. So, Sanders should bring the bill to the Senate floor for a vote instead of pursuing yet-another made-for-television hearing, during which he ignores the solutions presented to him. PBM reform actually will save money, which, for years now, is what Sanders says he wants.