Fact Sheets

The Spread Game
Initially, PBMs were put in place to create convenience.The idea was to create a simple, transparent process conducted for a flat administrative fee on a per claim basis. Over time, as PBMs came to control a larger share of the pharmacy market, they began marking up drug costs to increase their profits. Read more…

The Mail Order Repackaging Game
There are currently discrepancies between the cost of retail and mail order drugs, with mail order costing employers MORE than retail. Most PBM owned pharmacies repackage brand name drugs into different quantities and configurations than how they were originally supplied by the manufacturer. Read more…

The Rebate Game
Another flaw in the current PBM system involves the use of manufacturer rebates. Employers contract with PBMs to run their drug benefits. Employers often mistakenly believe they receive 100% of the rebates paid by brand name drug makers. In reality, PBMs often keep vast majority of this money before passing on a small percentage to the employer. Read more…

Fiduciary Responsibility
An industry that was developed to reduce employer drug plan costs and expenses is now the single greatest cause for yearly increases in per member per month (PMPM) drug costs. Much of a traditional PBM’s profits are now generated by hidden price schemes and manipulations designed to fatten the PBM’s pockets, not lower employer costs. Read more…

10 Questions Company Benefits Managers Must Ask Their PBM
National Community Pharmacists Association
Pharmacy Benefit Managers, often known simply as “PBMs,” are largely unrecognized by most employees — and even by many benefits managers. But they have a tremendous impact on U.S.health care decision-making because they influence more than 80 percent of drug coverage. Read more…

Facts and Myths about PBM Transparency
National Community Pharmacists Association
Language included in both the Senate Finance Committee and the House Energy and Commerce healthcare reform bills require “transparency” for any PBM that contracts with a health plan in the health insurance exchange. The Senate language also extends this requirement to Medicare Part D plans. Read more…

Mail Order Waste
National Community Pharmacists Association
A presentation documenting several real cases of excessive waste in the mail order pharmacy system. In one example of Express Scripts over utilization, a patient’s insurance provider was charged for more than $6,000 worth of medication after his death. After several attempts, his widow was unable to stop delivery. Read more…