The Trump administration’s recent efforts to increase transparency in hospital pricing have expectedly been met with legal push-back from the hospitals themselves. But shadowy hospital pricing is just the tip of the opaque iceberg that is driving up the costs of health care in America. To inject more competition into the industry, Congress and the […]
In every sector of the economy, transparent pricing ensures the survival of the most efficient firms and results in lower prices as firms compete for market share. There’s no reason to think the PBM industry is an exception. To read this op-ed, visit The Hill.
Consumers in Maryland are facing rapidly rising prices at the pharmacy counter, but drug makers’ prices have roughly kept pace with inflation over the last few years. What gives? It turns out that pharmacy benefit managers (PBMs), a very small number of largely unregulated companies that administer the drug plans of more than 230 million […]
If you’ve never heard of pharmacy benefits managers (PBMs), that’s the way they like it. While they administer drug plans for more than 230 million Americans, PBMs thrive on secrecy and a lack of transparency. Yet PBMs’ shady business practices deeply impact the lives of Marylanders by pushing up drug prices and limiting access to […]
Pharmacy Benefit Managers (PBMs) administer prescription drug plans for sponsors (e.g., employers and insurers), negotiate drug prices with manufacturers, and negotiate reimbursement terms with pharmacies. This ConsumerGram analyzes the structure, conduct and performance of the industry and finds that the lack of transparency in costs and prices leads to anticompetitive risks. The result can mean […]
As the new legislative session begins, Congress should demand increased transparency, require flow-through of manufacturer rebates to lower consumer prices, prohibit clawbacks, and consider giving federal agencies expanded oversight responsibilities to monitor PBMs’ practices. This op-ed explains why.
A massive, yet often unnoticed, business practice contributing to exorbitant drug prices in the U.S. may slowly be moving toward reform, according to a recent announcement by the largest practitioner. To read this op-ed, please visit Real Clear Health.
The harmful and anti-competitive business practices that PBMs thrive on are made possible by the industry’s secrecy and lack of transparency. Plan sponsors and beneficiaries should be given more information about how their insurance plans are managed and what rates are negotiated. Pharmacies should be allowed, and even encouraged, to point customers to lower-cost alternatives […]
Pharmacy benefits managers (PBMs), companies that administer prescription drug plans on behalf of insurers and employers, have recently come under increased scrutiny for the role they play in increasing prescription drug costs. By acting as middlemen in the process of negotiating drug prices between drug manufacturers and health plans, they create “an environment for conflicts […]
Pharmacy benefit managers (PBMs) administer prescription drug plans on behalf of insurers and employers. In the process, they negotiate reimbursement terms with pharmacies and drug prices with drug manufacturers. While plan sponsors face the direct financial costs of the prescription plans being offered to its members or employees, PBMs act as middlemen in the process. […]