Reining in the Maleficent Middlemen: Governor Cuomo Should Sign America's Toughest Prescription Drug Legislation
Gotham Gazette, September 30, 2019
Like the rest of America, New York State is ensnared in the stranglehold of our byzantine healthcare system, which today is best known for skyrocketing pharmaceutical drug prices and a rapid decline in quality of care. One of the most vicious, insidious, and disingenuous tentacles of that system choking the life out of us is the group of corporations known as Pharmacy Benefit Managers (PBMs).
While just three Fortune 25 companies – CVS, Express Scripts, and OptumRx – control nearly 80% of the pharmacy benefits market, most Americans are unaware of the outsized role PBMs play in their healthcare. And PBMs want to keep it that way.
Hired by insurance companies as their prescription drug middlemen, PBMs claim they play an important role in making prescription drugs accessible and affordable for consumers – including in New York’s Medicaid program – by negotiating prices with manufacturers.
In reality, however, PBMs control which medications are covered by insurance, what patients pay out-of-pocket and the amount pharmacies get reimbursed for dispensing them. PBMs are unregulated thieves who are not required to — and therefore don’t — disclose how much money they take in, how much they pay out, or the savings they achieve through this process.
When challenged to provide more transparency about their business practices, PBMs flat-out refuse. Why? Because a lack of oversight is their key source of power. And it’s the consumers, and the pharmacies that dispense medications, who pay the price.