PBMs Face Growing Public Scrutiny

July 1, 2022

As the role of pharmacy benefit managers (PBMs) in healthcare grows increasingly important, so does the scrutiny of the industry. While PBMs argue that they help increase access to vital medicines by lowering collective prices, many lawmakers and patient advocates in the US say the companies pocket much of the savings intended for patients.

According to John Russell, “Also last month, the Senate Commerce Committee advanced a bill that would prohibit pharmacy benefit managers from setting “spread pricing” and from clawing back payments made to pharmacies. Both usually happen behind the scenes, with little regulation or openness. Spread pricing occurs when a PBM reimburses pharmacies one price for a drug but charges the health plan another, pocketing the difference. Many pharmacists have complained that the reimbursement rate from PBMs is lower than the actual cost to acquire the drug, but they say they have no way to see what the PBMs are charging the health plans.”

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(Source: Indianapolis Business Journal, July 1st, 2022)

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