Senderra's Vice President Of Regulatory And Compliance, Tiffany Jones, attended a forum on the impact of pharmacy benefit managers (PBMs) in pharmaceutical markets on Wednesday, November 17th at the US House of Representatives in Washington, DC.
The Role of PBMs in Pharmaceutical Markets
The forum was held by Reform Ranking Member James Comer (R-Ky.) and other lawmakers who reviewed the impact of pharmacy benefit managers (PBMs) in pharmaceutical markets with experts, pharmacists, physicians, and PBMs.
The forum addressed concerns about higher drug costs due to PBMs market power. By negotiating with drug manufacturers and pharmacies to control drug spending, PBMs have a significant behind-the-scenes impact in determining total drug costs which can shape patients’ access to medications, and determining how much pharmacies are paid.
What Are Pharmacy Benefit Managers?
PBMs are contracted by health plans and employer groups to coordinate with drug manufacturers and process prescription-related claims. PBMs are the connectors between employers, drug wholesalers, members, and pharmacies. They are tasked with designing and managing drug benefit plans in the fast-growing pharmaceutical landscape.
How Does a PBM Affect Drug Prices?
- Develop formularies, of covered medications on behalf of health insurers, that determines which drugs patients use and sets out-of-pocket costs
- Use their purchasing power to negotiate rebates and discounts from drug manufacturers
- Contract directly with individual pharmacies to reimburse for medications dispensed to beneficiaries
PBMs Relationship With Specialty Pharmacies
PBMs claim to increase value by managing formularies and providing utilization strategies that aid in lowering costs and improving access coordination. As prescription drug prices continue to rise, there is heightened concern among policymakers, government agencies, and medical groups that PBMs are not delivering lower drug prices or improving value in drug spending. Today, there are no policies in place that require PBMs to disclose information about the size of their drug discounts and rebates.
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