Over half of every dollar spent on medicines goes to middlemen and others.
There’s a long line of middlemen profiting when you get your medicine. In fact, over half of every dollar spent on medicines goes to health insurance companies, pharmacy benefit managers (PBMs), big pharmacies, and others. They are driving up costs for patients.
Middlemen wield enormous power over patients.
Insurers and PBMs decide what medicines you can get and the price you pay at the pharmacy. Just three PBMs control 80% of the prescription drug market and the largest PBMs and insurers are owned by the same big health care conglomerates. They are consolidating their power even further by owning pharmacies and buying up doctors’ offices.
Middlemen refuse to share savings with patients.
Insurers and PBMs get billions of dollars in rebates and discounts that reduce the cost of brand medicines by 50% or more. Yet, they often force patients to pay based on the full price. As a result, patients can pay more for medicines than middlemen.
When patients use copay assistance to save money at the pharmacy, middlemen keep it for themselves or refuse to count it toward patients’ deductibles.
Middlemen drive up costs for everyone.
PBMs make money off fees and rebates tied to the price of medicines, which means they make more money when the price of medicines go up. Experts say this can lead them to deny or limit coverage of lower-cost medicines driving up costs for everyone while their profits soar.
Middlemen can profit from where you fill your prescription.
PBMs often steer people toward the pharmacies they own, regardless of what is in the best interest of the patient. A new FTC report shows this creates conflicts of interests that can increase medicine costs and squeeze out independent pharmacies.
It’s time to lower costs for patients by taking on the middlemen.
Related Resources
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Protect Copay Assistance: End Insurer and Middlemen Games That Drive Up Costs for Patients
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A Voter's Perspective: Alfred and Rebecca
Pharmacist, Dad, and Patient
Voters like Alfred and Rebecca, who live in Kentucky, overwhelmingly support solutions to help rein in insurance companies and their pharmacy benefit managers (PBMs). Join them in raising your voice to ensure that patients and doctors are the ones making decisions about medications, not PBMs who are more focused on bottom lines than quality of life.