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Open Letter to PCMA: Your Wounds are Self-Inflicted and Could Prove Fatal

Jul 25, 2022

Dear PCMA,

We need to talk. It’s not good news.

First, we feel we should thank you. Remarkably, your clients have somehow united the U.S. in a way usually reserved for terrorist attacks and tragic natural disasters.

Also, we’re impressed at your latest PR offensive. How fascinating to watch the public’s overwhelmingly negative reaction to your recently published opinion pieces defending PBM business practices and claims of value generation.

But it’s time for some tough love. Even your recently-released white paper assessing the (economic) value of pharmacy benefits management is stretching to salvage what may soon become an unsalvageable public image. At this rate you’ll soon join the ranks of the tobacco industry and other notorious industry charlatans who profiteered at the expense of people’s health and safety. You don’t really want that to be your legacy, do you?

The hard truth, PCMA, is this: your industry’s wounds are self-inflicted by years of insatiable greed and background exploitation of payers, patients, producers and providers. We think you know what we’re talking about.

How can we put this tactfully? It was a bit of an overreach to take credit for the “accelerated pace of drug innovation” ($6 billion per year in value created? Really?) and we collectively cringed when … how did you put it in your white paper’s “key takeaways” document? Oh yes, “fraud prevention … of potential financial and health … harms that come from misuse and improper payments”. Do the words “Tricare”, “Express Scripts” and “refill pill mill” ring a bell? No? How about “Centene”, “Envolve” and “$1.1 billion to settle pharmacy disputes”?

And then there’s this matter of the annual $145 billion value PBMs create, according to your expert. That would be so amazing if it were true, and if we’re talking within the strict framework of the paper’s economic theory, the point (but not the dollar figure) would be inarguable.

It’s just that there’s also this little problem of value distribution, which your paper conveniently ignores. The evidence - let’s go with the publicly-available industry 10Ks as reported to the SEC - suggests the vast majority of the “value” generated by PBMs is distributed right back to the PBMs and not to consumers, let alone payers, producers or providers.

The reality is, PCMA, if you continue to allow the PBM industry to engage in non-transparent, non-fiduciary, conflict-of-interest business practices, this current hemorrhaging of credibility and competitive integrity may soon prove fatal.

Now might be a good time to take a step back and reflect, but maybe not such a good time to continue investing millions in PR, lobbying and other tactics that, though they may echo the narrative PBMs want everyone to buy into, ring hollow in the real world. Don’t take our word on the narrative - just ask any of the 30+ commenters to your recent Wall Street Journal op-ed.

We hope our words will not fall on deaf ears. Remember, it’s never too late to turn over a new leaf, adopt helpful instead of harmful business practices and become the industry you might have been.

Yours in transparency,
The PUTT Board of Directors

PS: The schadenfreude is exquisite, thank you

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