Drug pricing reform has received renewed attention in recent months, but one entity always seems to escape unscathed in reform efforts: pharmacy benefit managers (PBMs). In their original form, PBMs adjudicated pharmacy claims but over the years, these entities evolved into money-making behemoths at the expense of patients and employers.
The top three PBMs control more than 80% of all prescriptions. What is hidden from public view is higher price drugs bringing in higher profits for PBMs. This trend forces our patients to carry the additional burden of higher costs — often for drugs that may not be best for their care.
The “tools” PBMs use to create the most profitable formularies can make chronically ill adults and children take drugs that their physicians know won’t work for them all in the name of profit. This is not to place all of the blame on PBMs for higher drug prices, as we know manufacturers share in that blame as well.
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