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PBMs act as third-party “middlemen” who negotiate the price
pharmacies and insurance companies pay for prescription drugs
from the manufacturers. Their role is supposed to involve
negotiating the cost of drugs to save patients money, but
critics contend they are actually driving costs up.
The U.S. Department of Health and Human Services reports between
January 2022 and January 2023, more than 4,200 drugs saw a price
increase on average of more than 15%.
Gov. J.B. Pritzker recently took part in a roundtable discussion
on the topic of PBMs and called for the passage of the
Prescription Drug Affordability Act.
“It is going to take aim at the common ways that PBMs game the
system to profit at the expense of Illinois families and
employers,” said Pritzker. “Many of those employers that are
really deeply, negatively affected are small and medium-sized
businesses.”
If passed into law, the legislation would create an independent
Prescription Drug Affordability Board. The board could set upper
limits on what people would pay for their medications.
There has been a national movement for more PBM regulation. The
Trump administration is taking steps to meet with pharmaceutical
companies to examine PBMs and discuss reforms to possibly
eliminate PBMs.
Conner Rose with the Pharmaceutical Care Management Association
said a study by the Federal Trade Commission looked favorable on
PBMs.
“Specifically, PBM ownership of mail order pharmacies which, the
study demonstrated that PBM ownership of mail order pharmacies
actually do provide value to consumers in the form of lower drug
costs,” said Rose during a committee hearing last year.
Some drug manufacturers contend that it's expensive to develop
new drugs and run the required clinical trials. |
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