{"id":18364,"date":"2021-03-24T14:26:05","date_gmt":"2021-03-24T14:26:05","guid":{"rendered":"https:\/\/nclnet.org\/?p=18364"},"modified":"2021-03-29T13:35:51","modified_gmt":"2021-03-29T13:35:51","slug":"pbms_driving_drugcosts","status":"publish","type":"post","link":"https:\/\/nclnet.org\/pbms_driving_drugcosts\/","title":{"rendered":"Consumers face an unfair disadvantage at the pharmacy counter"},"content":{"rendered":"

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By Sally Greenberg, NCL Executive Director<\/strong><\/p>\n

Everywhere we turn these days, we find ourselves wondering if we are getting a fair deal. Americans continue to suffer the economic consequences of a year-long global health pandemic, and many of us are trying to stick to the essentials and stretch our dollars where we can. As COVID-19 has reminded us, there aren\u2019t many issues families face that are more significant than access to health care.<\/p>\n

Families can\u2019t go without essential prescriptions and often wonder why the price seems to go up each time they go for a refill. In fact, we are likely paying more than necessary at the pharmacy counter, but we don\u2019t often know \u2014 or even think to ask \u2014 why.<\/p>\n

A variety of factors drive drug costs, some of which are obvious: the cost of research and development, distributing the product, the pharmacies\u2019 profits \u2013 but there is one far less known cause of price increases: PBMs, short for pharmacy benefit managers.<\/p>\n

Most people have never heard of PBMs, and PBMs like it that way. They are billion-dollar companies that control more than 80 percent of the prescription drug formularies, (formularies are the lists of drugs that a health plan allows its members to access) \u2014 in the United States.<\/p>\n

Because of their outsized role, too often PBMs determine how much consumers, businesses, government agencies, and others pay for medicines. As originally conceived, PBMs were meant to help ensure that patients get a fair deal by:<\/p>\n