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Are Pharmacy Benefit Managers' Cost-Containment Claims a Shell Game?
In today's political climate, one of the hottest topics is the rising cost of healthcare and drugs. Following the last election, all industries should anticipate change, especially in healthcare. While much of the focus is currently on whether the Affordable Care Act will be repealed, one of the areas the government continues to scrutinize is costs.
As highlighted by political candidates and news agencies, prescription medications are driving up the cost of healthcare. Pharmacy benefits managers, or “PBMs,” as they are known in the industry, administer the prescription drug benefits for almost all health insurance plans. And while they do not control drug prices established by drug manufacturers, they do have significant influence on the prices charged by such manufacturers.
PBMs play a critical role beyond simple drug claims administration in the healthcare plan process, but few people are familiar with the term “PBM,” and even fewer understand how PBMs operate and, most importantly, how they generate profits. While PBMs claim that they are effective in controlling or minimizing rising drug costs for their clients, it is arguable that their methods actually raise medication costs, in their quest to increase their own profits.
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