Congress Waking Up to PBMs Drug Cost Manipulations

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Members of Congress on both sides of the aisle are examining how industry middlemen known as Pharmacy Benefit Managers (PBMs) are driving up healthcare costs. Rightly so. PBMs have been manipulating the complex and opaque drug pricing system at the expense of patients for far too long and Congress must act.

PBMs work for (or increasingly are part of) insurance companies. They decide which drugs patients can access and negotiate rebates to drugs’ list prices. The term “rebates” sounds like these discounts should benefit patients, but PBMs and insurers pocket these savings while basing patients’ costs on the higher undiscounted prices.

This practice inequitably shifts more costs onto patients relative to what their insurance benefit design would indicate and, troublingly, encourages too many patients to not fill their prescribed medications.

Read the full article by Sally Pipes and Wayne Winegarden at RealClearHealth

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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