A lack of regulation of Pharmacy Benefit Managers (PBMs), allows these giant corporations to operate in the dark and increase costs for families, local pharmacies and taxpayers. PBMs are destroying the patient pharmacist relationship in America.
PBMs are prescription drug middlemen who manage the transaction between pharmaceutical manufacturers, health insurance agencies, pharmacies, and ultimately every day families. A severe lack of transparency and oversight has left them with too much financial power, and the process by which they make money is confusing by design so that they can keep profits underwraps.
How Prescription Drug Middlemen Game the System
The Fox Guarding the Hen House
Some PBMs are owned by or own the pharmacies they mandate or steer patients to use. It’s not only anti-competitive, but anti-patient. Prescription drug middlemen are determining where you can go to get your prescription drugs, and the amount that the pharmacies will be reimbursed for a prescription. These middlemen own retail, mail order and specialty pharmacy facilities; they set reimbursements for themselves and their competitors (i.e. local neighborhood pharmacies), and they can force a patient to use their pharmacies they own.
The Rebate Game
The “Rebate Game” is the most common and most detrimental. While this sounds like a good thing, it’s simply a bribery system that leaves families on the losing end. Essentially, the prescription drug middlemen go to drug manufacturers that produce similar medications and select the medication developed by the manufacturer that gives them the bigger rebate. This drug is now on your plan’s drug list all because a prescription drug middleman got a bigger kickback. Health insurance companies get some of the rebate, but a percent of the rebate goes into a PBM’s own pocket. Gone are the days when a pharmacist can help patients find the medication that works for their health and budget.
Where do the negotiated manufacturer rebates go? How much is the prescription drug middlemen keeping? Are these unregulated, dark payment processes orchestrated by the prescription drug middlemen contributing to the overall high costs of prescription drugs?