publication date: Apr. 12, 2019
Your PBM primer: Senate Finance Committee hearing focuses on the mysteries of pharmacy benefit managers—their power and role in rising drug prices
By Claire Dietz and Paul Goldberg
Pharmacy benefit managers, like climate change, germs and, possibly, God, are all around, and if we could clear a few hours, it would be good to learn enough about them to sustain a cocktail party conversation.
Earlier this week, the Senate Committee on Finance trained a Klieg light on PMBs and the role they play in escalating America’s drug prices.
“PBMs negotiate with the drug companies, as well as pharmacies, to arrive at a price for a drug and its ultimate cost,” Sen. Chuck Grassley (R-IA), committee chairman, said at the hearing April 9. “In addition to negotiating prices, PBMs also determine what drugs are covered and what patients pay out-of-pocket.
“The current system is so opaque that it’s easy to see why there are many questions about PBMs’ motives and practices. Mergers and vertical integration is another area that has increasingly prompted concern.
“All of the PBMs here today are owned by or affiliated with an insurance plan. In many cases, the combined company also owns pharmacies and other players in the health industry,” Grassley said. “It’s important we look to see whether such integration actually helps patients and consumers, or whether it just opens the door for anti-competitive behavior.”
Sen. Ron Wyden (D-OR), the ranking member of the committee, described PBMs as “one of the most gnarled, confounding riddles in American health care today.”
“Pharmacy benefit managers are among the most profitable companies in the nation. What PBMs do to earn all those profits is … Continue reading Your PBM primer: Senate Finance Committee hearing focuses on the mysteries of pharmacy benefit managers—their power and role in rising drug prices
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