Myth: PBMs lower healthcare costs
Fact: Ask someone who works in human resources if their company’s prescription drug costs have ever gone down from one year to the next. More likely than not, the answer will be no. PBMs claim to drive down drug costs by leveraging their purchasing power and negotiating with drug makers and pharmacies. PBMs routinely fail to pass savings on to clients.
Myth: PBMs look out for employers, taxpayers and consumers
Fact: PBMs are not fiduciaries, they are players in a thriving multi-billion dollar industry. The consequences of PBM abuse are significant.
Myth: Mandatory Mail Order programs lower drug costs
Fact: Mandatory Mail Order (MMO) is an increasingly common tactic employed by PBMs to secure larger market shares. MMO requires enrollees order 90-day supplies of maintenance medications (drugs taken for extended periods of time to treat chronic conditions) directly from pharmacies owned or contracted by PBMs. While customers may save on co-pays, employers fall victim to another PBM scheme and pay far more for mail order than retail. Legislation banning MMO was approved by both houses of the New York State Legislature in 2011. Similar legislation is being drafted in Pennsylvania.
Myth: Mandatory Mail Order Programs raise adherence rates
Fact: PBMs say MMO programs raise medication adherence rates, but a number of recent studies cast doubt on their claim. One such study conducted by researchers from CVS Caremark, Harvard University and Brigham And Women’s Hospital found that MMO programs actually curtail adherence by virtue of being mandatory. The study was published in the July issue of the American Journal of Managed Care.
Myth: Rebates from drug manufacturers are distributed equally
Fact: PBMs receive rebates from drug manufacturers to incentivize the sale of their drugs over a competitor’s. PBMs keep majority of the rebate dollars rather than pass them on to employers in the form of savings.
Myth: PBMs take a fair share of prescription drug sales
Fact: What is the fair share for the middlemen who unnecessarily inserts themselves into
the prescription drug trade? PBMs routinely charge employers hundreds of dollars more for prescriptions than they pay the pharmacies to fill them.