‘Heat wave’ for pharmacy benefit managers as lawmakers, regulators scrutinize impact on drug prices
Political and legal troubles are piling up around the companies that act as influential middlemen in the U.S. prescription-drug system.
And in a Congress that has few points of bipartisan agreement, lawmakers on both sides of the aisle have shown interest in investigating or restricting some PBM practices. The Senate Commerce Committee last week approved a bill that would prohibit certain PBM pricing practices and require the companies to disclose more information on how they’re paying pharmacies for drugs, among other details.
Central players who influence drug cost and access As central players negotiating with drugmakers and pharmacies, PBMs can influence which drugs are prescribed to patients, patient access to medications, payment terms for pharmacies, total drug costs for insurers and how much patients ultimately pay for their drugs, researchers and regulators say.
PBMs say they play a critical role in securing drug savings, supporting patients’ access to prescriptions and promoting better health outcomes. The Pharmaceutical Care Management Association, a PBM trade group, said in February that it was launching a seven-figure advertising campaign to highlight “the irreplaceable value of America’s pharmacy benefit companies” and promote ideas to increase competition as the best way to address high drug prices.
The high sticker price matters, Feldman said in her testimony, in part because in many insurance plans the patient’s out-of-pocket cost is calculated as a percentage of that sticker price. It also matters to the many Americans who don’t have prescription-drug coverage, she said.
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