A new bill in Congress would end some of the most egregious practices of Pharmacy Benefit Managers (PBMs), reports Annika Kim Constantino for CNBC. PBMs are the drug middlemen who negotiate lower drug prices from manufacturers and then tend to pocket the savings for themselves or the health insurers who own them. The bill sounds appealing, but the only way to ensure fair drug prices for Americans is to remove the PBMs from the mix and have the government negotiate drug prices directly with the pharmaceutical manufacturers, as every other wealthy country does.
Right now, the PBMs are driving up drug costs and forcing millions of Americans to forgo or delay filling their prescriptions. The PBMs are also driving community pharmacies out of business by underpaying them for their services or steering customers to pharmacies that promote the PBMs’ financial interests. The Congressional bill would make it easier for people to use community pharmacies, help ensure the PBMs pay these pharmacies appropriately, and lower people’s drug costs.
This bill is not the only bill attempting to address high drug costs and abuses by the PBMs. And, though it’s bipartisan, it’s not at all clear that it will become law. Because the insurers and PBMs are so powerful, Congress is often hamstrung in its efforts to address their bad acts. Three PBMs–Optum Rx, Express Scripts and CVS Caremark–control about 85 percent of the prescription drug market and are owned by big insurers.
Fortunately, the FTC is also working to address PBM abusive and unfair practices harming consumers. It plans to sue the three largest PBMs, which control about 80 percent of the market.
If passed, the bill in Congress would create a new model for paying pharmacies. For reasons I can’t explain, today, PBMs can reimburse pharmacies less than what the pharmacies pay for drugs. The bill also would require PBMs to pass along to patients 80 percent of the savings they negotiate. And, it would forbid PBMs from steering patients to brand-name drugs when lower-cost generics are available.
Here’s more from Just Care:
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