Policymakers, federal agencies, the media and others continue to raise concerns over how pharmacy benefit managers (PBMs) put profits ahead of patients. The FTC’s latest report on PBMs unveiled more evidence of ways these powerful middlemen are inflating costs and squeezing out independent pharmacies with their abusive tactics.
At the same time, voters continue to voice their concerns over PBM practices and call on policymakers to act.
Here are some examples.
Driving up costs
- “As a registered nurse, I’ve seen how difficult it can be for patients struggling to access and afford the critical care, treatments and prescription drugs they need due to the harmful practices of Pharmacy Benefit Managers (PBMs). These financial burdens only create more stress for patients, many of whom are already fighting for their lives. This is not how America’s healthcare system should work, and it is long past time for Congress to protect patients from these harmful policies.” – Amanda from New York
- “PBMs control roughly 80% of the prescription drug marketplace to-day. Instead of using that power for good, these groups use it to control when and where patients can access the life-saving medications they need. Broken PBM policies can also force patients to pay higher out-of-pocket expenses. Policymakers should lead on this issue and…rein in and reform harmful PBM practices that threaten patients as soon as possible.” – Mary from California
Limiting access
- “PBM policies can make that process of accessing prescription medications harder because they’re able to limit where you can pick up your prescriptions using nonsensical patient ‘steering’ policies. In short, these groups just have too much power and control over patients and the entire prescription drug marketplace. It’s about time for lawmakers to shine a light on the shameful pharmacy benefit managers (PBM) practices that threaten patient access and contribute to the lack of pharmacy access for rural patients and communities.” – Michelle from Nevada
- “This is an issue that impacts tens of millions of Americans, regardless of political affiliation, and I cannot understand what is taking lawmakers in Washington so long to address it…These insurer-owned groups only care about protecting and increasing their profits by any means necessary, even if that means threatening access and increasing prescription drug costs and out-of-pocket expenses…They should not be able to throttle access to prescriptions by using harmful policies like step therapy and prior authorization….” – Callie from Montana
Refusing to share savings
- “As healthcare middlemen, PBMs exploit vulnerable patients, taking advantage of the 340B program and refusing to pass down savings to patients. During the negotiation process, PBMs secure sizeable prescription drug rebates directly from manufacturers. These rebates should be passed down to patients to help reduce their out-of-pocket burden at the pharmacy. However, PBMs are far more likely to withhold these savings to further inflate their profit margins.” – Terry from Minnesota
Driving out independent pharmacies
- “PBMs also regularly steer customers towards larger chains in which they are financially vested. Vertical integration of PBMs with their own pharmacy chains creates conflicts of interest…[which] undermines the financial stability and competitive viability of independent pharmacies, threatening their existence and reducing healthcare options for patients. PBM reform is essential if we are to avoid further closures of independent pharmacies in Oregon.” – Victor from Oregon
A recent Morning Consult/PhRMA poll builds on these themes showing 81% of Americans are concerned that PBMs influence what medicines patients get and control what patients pay at the pharmacy. The same poll found 84% of Americans agree that policymakers should focus on cracking down on abusive practices by health insurance companies and other middlemen that make it harder to get the care they need.
Patients are fed up with middlemen putting profits before their health care. Policymakers must fix the broken system and take on the middlemen that are limiting access, driving up costs and driving out competition.
