In defense of PBMs

by JC Scott ([email protected]) 671 views 

In Arkansas, Washington, D.C. and state capitals across the country, there have been heated discussions over the role pharmacy benefit managers (PBMs) play in today’s health care marketplace.

Simply put, the core mission for PBMs is to be the primary advocate for consumers and health plans in the fight to keep prescription drugs accessible and affordable. PBMs negotiate on behalf of consumers and are able to keep a lid on overall costs for prescription drugs with market-based tools that encourage competition among drugmakers and drugstores and incentivize consumers to take the most cost-effective and clinically appropriate medication.

It’s time to set the record straight on PBMs and their value to consumers.

• Lower Prescription Drug Costs
PBMs are the only check against drug manufacturers’ pricing powers. Every year, PBMs advocate on behalf of more than 266 million consumers with health insurance to keep prescription drugs accessible and affordable. Evidence shows PBMs generate significant savings for government programs, health plans and consumers. In fact, from 2016 to 2025, PBMs are expected to save $654 billion on prescription drug costs, and every day, PBMs are saving consumers and health plan sponsors an average $123 per brand-name prescription.

In fact, thanks to PBMs’ cost-containment efforts such as rebates and discounts, net prescription drug spending grew 2.3% in 2016 and just 0.4% in 2017. Unfortunately, there is still insufficient competition among prescription drugs in specific therapeutic areas, resulting in higher prices for some drugs and higher out-of-pocket costs for some patients.

• Real-time Access to Medications
Whether on the state or federal level, policymakers must take care not to disrupt consumers’ access to prescription drugs. Right now, PBMs are the only part of the healthcare system with the expertise to provide consumers with real-time access to affordable prescription drug benefits. Without PBMs, Arkansas’ consumers could find themselves standing at the counter as their local pharmacists struggle to determine their cost-sharing and how much the pharmacies themselves are owed.

• Greater Transparency
PBMs support and practice transparency that empowers patients, their providers, plan sponsors, and policymakers, so that there is informed decision-making that can lead to lower prescription drug costs.

Drug manufacturers alone have the power to set and raise prices. PBMs are the advocates for consumers and health plans in the fight to keep prescription drugs accessible and affordable.

Editor’s note: JC Scott is the president and CEO of the Pharmaceutical Care Management Association (PCMA), which represents America’s pharmacy benefit managers. Scott can be reached at [email protected]

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