Do Patients Benefit from PBMs?
While the large PBMs claim that they lower prescription drug costs for you and the sponsor of your prescription drug plan, their track records suggest otherwise. It seems any discounts or rebates they negotiate with manufacturers is used to inflate their corporate profits rather than lower your costs.
According to a recent report by the American Consumer Institute, “consumers are paying more because of higher invoice prices, while PBMs are profiting more because of a surging increase in manufacturer rebates. The rebates are not flowing through to consumers in the form of lower prescription prices.”
Other practices that PBMs claim “lower costs” may have a detrimental impact on your access to medications while providing little, if any, evidence that the practices actually reduce costs. For example, PBMs utilize their market power to devise prescription drug plan designs that may steer you to their affiliated pharmacies while refusing to allow your preferred pharmacy in their network. This is particularly detrimental if you live in a medically underserved community where your preferred pharmacy may be the only pharmacy in town.
Additional “cost saving” methods such as prior authorizations and step therapy, where you have to first prove that your PBM’s preferred medication is ineffective for you before you can have access to the medication your doctor specifically prescribed for you, can leave you waiting months to effectively address your condition. While you are forced to endure ineffective treatment, your PBM benefits from having you take its preferred treatment, which may provide it a higher rebate at the expense of your health.
According to a recent report by the American Consumer Institute, “consumers are paying more because of higher invoice prices, while PBMs are profiting more because of a surging increase in manufacturer rebates. The rebates are not flowing through to consumers in the form of lower prescription prices.”
Other practices that PBMs claim “lower costs” may have a detrimental impact on your access to medications while providing little, if any, evidence that the practices actually reduce costs. For example, PBMs utilize their market power to devise prescription drug plan designs that may steer you to their affiliated pharmacies while refusing to allow your preferred pharmacy in their network. This is particularly detrimental if you live in a medically underserved community where your preferred pharmacy may be the only pharmacy in town.
Additional “cost saving” methods such as prior authorizations and step therapy, where you have to first prove that your PBM’s preferred medication is ineffective for you before you can have access to the medication your doctor specifically prescribed for you, can leave you waiting months to effectively address your condition. While you are forced to endure ineffective treatment, your PBM benefits from having you take its preferred treatment, which may provide it a higher rebate at the expense of your health.