Another Sneaky PBM Practice Needs to End

When the nation’s largest pharmacy benefit manager (PBM), Express-Scripts, and the insurance giant Anthem, Inc. sued each other last year over how much each company made in profits, the curtain was raised on the oversized role PBMs play in determining what consumers pay for their prescription drugs.

Hired to administer insurers’ prescription drugs plans, PBMs negotiate lower drug prices with pharmaceutical manufacturers and lower reimbursement rates with pharmacies, ostensibly to save money for employers and consumers. However, because PBMs operate without transparency, there is no way to know how much of the savings from lower prices are passed along to consumers.  This is why many of the largest corporations formed the Health Transformation Alliance to overhaul the way PBMs are paid and 28 states passed laws regulating some aspects of PBM operations. Additionally, Senator Ron Wyden (D-OR) recently introduced the “Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act” to require PBMs to disclose the amount and proportion of the rebates from drug manufacturers that are passed on to health plans.

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