Pharmacy Benefit Companies Are More Valuable Now Than Ever

(JC Scott) - Recently, there has been a lot of discussion by politicians about how to address prescription drug prices and out-of-pocket costs for Americans. Unfortunately, some of that discussion has wrongfully pointed the finger at pharmacy benefit companies (PBMs).

How do PBMs work? PBMs help ensure more than 275 million Americans can get the medicines they need, easily and affordably. Your employer or health insurance company chooses to hire a PBM for their expertise in prescription drugs and pharmacy benefits. PBMs negotiate directly with drug companies to lower drug costs by $1,040 per patient every year. They also reduce medication errors, provide valuable clinical services, and help keep patients healthy.

Because of the savings PBMs secure, drug companies who want to be paid more for their products and pharmacies that want to be paid more for their services are funding self-interested attacks on the PBM industry.

Americans should be skeptical of these attacks on PBMs – the only stakeholder dedicated to lowering drug costs.

Concerningly, some members of Congress have taken the bait from drug companies and are considering misguided policies targeting PBMs. For example, a proposed policy called “delinking” is being pushed as a solution, yet respected economists from the University of Chicago, USC Schaeffer Center, and Jack Kemp Foundation agree that the policy would instead increase costs for patients, employers, and taxpayers.

Fortunately, encouraging innovation in the pharmacy benefits market is improving how patients access and pay for their prescription drugs. For example:

• The PBM marketplace has grown more competitive with over 70 full-service companies offering varying benefit design and contracting options.
• In light of rising drug prices, PBMs have implemented new innovative offerings to help employers lower out-of-pocket costs for patients.
• PBMs have responded to the high list prices of popular GLP-1 weight loss medications by negotiating savings and providing employers options to cover these drugs.
• Greater biosimilar uptake is being encouraged by PBMs, as a more affordable alternative to high-priced brand name drugs.
• PBMs are empowering pharmacists to practice at the top of their license and implementing programs to support rural pharmacies.

Policymakers have an opportunity to deliver what patients need when it comes to prescription drugs – lower costs and better access. By encouraging the market to continue innovating to address these needs and tailoring policies to promote competition and build on this progress, we can work together to help patients have affordable access to the drugs they need.

Learn more about how PBMs are delivering value to patients, employers, and pharmacies at www.HowPBMsWork.org.