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.

Restoring Pharmacist and Patient Relationship​

Families have felt the impact of adding in prescription drug middlemen to the health care system. The ambiguously named “Pharmacy Benefit Managers” are prescription drug middlemen who get between you and your health care decisions. While they started out as a tool for health care plans to more easily and better control pharmaceutical costs and manage pharmacy networks, their role has grown beyond their original intended purpose. These middlemen are destroying the relationship between pharmacist and patient. This relationship that used to help guide patients to what works best for them. It's our goal to not only cut out the middleman but to restore the human side of health care.

Competition is Good

We firmly believe that competition is good. It’s what has driven pharmacists throughout history. Competition keeps industries in check and results in better services for Florida families. Unfortunately, just 3 PBMs, who are Fortune 15 companies, control 85 percent of the health care market and health care decisions for more than 260 million Americans. The system is rigged against every day families in favor of faceless corporations. Some prescription drug middlemen are even owned by or own the pharmacies they mandate or steer patients to use. PBMs determine which pharmacies are in their network and the amount that the pharmacies will be reimbursed for a prescription. It’s not only anti-competition, but anti-patient.

Profiting on a Pandemic?

Because prescription drug middlemen have been allowed to operate with little regulatory oversight, they are legally allowed to keep us all in the dark on how they make their money. That means as treatment options are developed for new diseases, including COVID-19, pharmacy benefit managers can get kickbacks for steering patients to specific medication. Gone are the days when you get to decide who to listen to: your physician and pharmacist or a prescription drug middleman who stands to profit off a pandemic.

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.

Questions Remain

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?

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