PBMs, The Reason for High Cost of Prescription Medication.

PBMs, The Reason for High Cost of Prescription Medication.

A short overview.

The High Cost of Prescription Medication. Are PBMs to Blame?

WASHINGTON, D.C. – House Committee on Oversight and Accountability Chairman James Comer (R-Ky.) released a report detailing alleged anticompetitive practices employed by the three largest Pharmacy Benefit Managers (PBMs): CVS Caremark, Express Scripts, and OptumRx. The report asserts these practices have resulted in the monopolization of the pharmaceutical marketplace, increased prescription drug prices, and adversely affected community pharmacies and patient access. The Committee convened a hearing with PBM executives address these allegations.

Chairman Comer stated, "Evidence obtained by the House Oversight Committee indicates that these PBMs have engaged in collusive activities to maximize profits, thereby jeopardizing patient care, undermining local pharmacies, and inflating prescription drug costs." He emphasized the Committee's commitment to exposing harmful PBM practices and advocating for legislative solutions to enhance transparency and accountability.

The report, "The Role of Pharmacy Benefit Managers in Prescription Drug Markets," presents evidence demonstrating how PBMs manipulate prescription drug costs and compromise patient care for financial gain. Key findings include:

• Anticompetitive Conduct: PBMs leverage their integrated positions across the healthcare sector to implement anticompetitive strategies, including steering patients to affiliated pharmacies and artificially lowering reimbursement rates for competitors.

• Opaque Pricing and Utilization Schemes: Despite claims of cost savings, evidence suggests PBM practices, such as spread pricing, often increase costs for payers and patients.

• Formulary Manipulation: PBMs prioritize higher-cost drugs with substantial rebates on their formularies, hindering the adoption of lower-priced alternatives, like generics and biosimilars.

• Offshore Operations: PBMs have established foreign entities to potentially evade transparency requirements and regulatory reforms.

• Detrimental Impact on Patient Care: PBM utilization management tools, such as prior authorizations, negatively affect patient health outcomes and delay the uptake of cost-effective medications.

• Increased Costs and Reduced Patient Choice: PBMs are alleged to have overcharged taxpayer-funded health programs and restricted patient access to preferred pharmacies.

  
  

The report concludes that legislative reforms are necessary to enhance PBM market transparency and address these alleged anticompetitive practices.

***Due to the complex pricing structures employed by Pharmacy Benefit Managers (PBMs), many consumers are unaware that the cash price of their prescription medication may frequently be lower than their insurance copayment. This discrepancy results in patients paying more through their insurance benefits than they would if they purchased the medication directly.

Patients are advised to inquire about the cash price of their prescriptions, as it may be more economical than the insurance copayment. It is important to note that some large chain pharmacies may inflate cash prices, potentially making the copayment appear more advantageous.

Apotek Pharmacy prioritizes patient transparency by informing individuals when their insurance copayment exceeds the cash price of their prescription.

For information regarding the cash price of your medication, please contact us today.