There are so many bad actors in the health care ecosystem that it’s hard to keep track of them all! That’s why we’re here – to try and break down some of these complicated and bloated systems to ensure that you have the information you need – and when you have the energy and time – to have a voice in the midst of the chaos!
This discussion is about PBMs and how they affect your medication costs!
Pharmacy Benefit Managers. PBMs are middlemen that negotiate and manage prescription drug benefits on behalf of health insurance companies, self-insured employers, and government programs. Express Scripts, CVS Caremark and Optum RX are the 3 main ones that control 80% of all medications.
The idea is that they negotiate for lower costs since they buy in bulk – Costco for Drugs so to speak – and then pass the savings on to you.
Uh.
Yah.
Nope.
They are not passing the savings along to us. PBMs pocketed 540 billion dollars in profit in 2023, instead of passing savings along to their customers. They are getting medications at a greatly reduced price, selling them to patients at the original or close to list price, and pocketing the extra dough for themselves.
And then to add insult to injury, they prohibited access to essential, new and life altering medications. In fact 600 medications were excluded from formularies for the three largest PBMs.
The Pharmacy Benefit Manager Transparency Act of 2023 was introduced by the Senate commerce committee. It would ensure that PBMs pass along 100 percent of any rebate to the health plan or payer while also ensuring that information regarding cost, price, discounts, rebates etc. are clearly communicated.
If you or a loved one has a moment – contact your Senator and let them know you support the Pharmacy Benefit Manager Transparency Act of 2023. You can visit your Senator’s website to fill out an email form or CLICK HERE to find the Senate search tool to located the address and phone number for your Senator.
