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. […]
Today, the American Consumer Institute published a new educational ConsumerGram on Pharmacy Benefit Managers (PBMs) and how their market influence and lack of transparency can influence consumer drug pricing. PBMs are virtually unregulated in what is an otherwise regulated health care sector. The ACI analysis of the PBM market highlights several issues surrounding PBM negotiations […]
A consumer needs a prescription filled and goes to their local pharmacy. The pharmacist asks for your prescription benefits card, does some paperwork, gives you a generic drug and charges you according to your plan’s standard deductible, say $15. That may seem like a typical experience, but what this consumer may not have known is […]