A November 27th Washington Examiner article likened pharmacy benefit managers (PBMs) to the fictional crime family The Sopranos. The article referenced a New York Times piece outlining how drug companies, insurers, and pharmacies band together to establish monopolies. Pharma executives claim that patients benefit from improved care, but limiting drugs to certain institutions via PBMs actually does the opposite.
PBM negotiators have no medical training and often aren’t familiar with the therapies they’re managing. They receive both a reimbursement fee and an administrative fee each time they place a drug “on formulary” and receive rebates from manufacturers that don’t trickle down to the consumer. A lack of transparency allows them to employ “spread pricing,” or the difference between what they charge a health plan for a drug and what it reimburses a pharmacy for dispensing it.
The author suggests the way to combat PBMs is to expose their shady activities and educate the public, patients, physicians and legislators in Washington.
