ST. LOUIS, Mo. - Placing the blame for the high price of prescription drugs is complicated, but an independent pharmacy owner we interviewed points his finger at pharmacy benefit managers (PBM). He asked us to hide his identity for fear of retribution.
“The PBMs like Express Scripts, CVS Caremark, Optimum RX, the top three,” said our source.
These pharmacy benefit managers are hired by insurance companies to manage drug plans. The PBMs negotiate with drug manufacturers and decide the drugs each plan will cover. In turn, the drug makers give PBMs discounts, called rebates, which they pass along to insurers which can lead to lower premiums for consumers. But our source says it’s a flawed system.
“We need to get rid of rebates. If the rebates and all the other fees that are paid to the PBMs and insurances companies to be on their formularies were dropped, and the drug companies were forced to lower their costs by that amount, we all save,” added our source.
He says the trickle-down can devastate small pharmacies.
“If we don’t get paid enough to survive, we’re out of business. And in some small towns, the only healthcare you have is the pharmacy,” said our source.
According to the National Institute on Money in Politics, the pharmaceutical industry contributed nearly $18 million to candidates nationwide running for federal office in 2018. In Missouri and Illinois, candidates running for state office received more than $4.6 million from big pharma over the last five years.
“We just really need federal legislation to fix this. We need transparency from the PBMs. If they had to tell what they were doing, things would change overnight.”
In the meantime, he says there are other ways to save money on your meds," said our source.
“When they go and pay for their prescription they can go and ask is there a cheaper plan out there. In the past, the PBMs had these gag rules that said we can’t tell you there’s a cheaper alternative.” Added our source.
With Congress now examining the high cost of prescription drugs, The Pharmaceutical Care Management Association, which represents PBMs, issued a statement that reads, in part: “While only manufacturers have the power to set prices, we recognize that we all have a role to play in helping to lower costs. As Congress looks into drug pricing, we know that more needs to be done, and we believe the key to reducing prescription drug costs is increasing and encouraging competition.”