The healthcare market in the U.S. has been the source of controversy for several years. Among the controversial topics associated with the U.S. healthcare system is the use of Pharmacy Benefit Managers (PBM). PBMs are used to link drug manufacturers and pharmacies with the cost of drugs set by the Pharmacy benefit Manager. Stat News explains the fees charged by PBMs are being investigated by lawmakers in several states.
What Does a PBM do?
The subject of PBMs has been a difficult one for pharmacy customers to understand. The Indianapolis Business Journal reports Pharmacy Benefit Management companies to create contracts with pharmaceutical manufacturers, which set the price paid for the drug. The PBM will then create a contract with individual pharmacy owners to give access to a wide range of medications. The pharmacy owner pays a fee to the PBM each time they purchase a drug from an approved manufacturer.
The Problem with Pharmacy Benefit Managers
One of the problems facing pharmacy owners is the high cost of working with a PBM. Pharmacy owners across the U.S. are reporting the cost of contracts with a PBM has been rising recently. The Pharmacy benefit Management industry charged fees to local pharmacies of more than $402 billion worth of medications in 2020. In a single county, Pennsylvania's Lehigh, local officials estimated $1.4 million was lost to the local economy. Pharmacists in Lehigh County could have saved their customers $1.4 million had they been able to search for competitive pricing on pharmaceuticals.
Adding Oversight
One of the issues local and state lawmakers have had with Pharmacy Benefit Managers is the lack of oversight they have enjoyed. Indiana was one of the first states to regulate the PBM market in 2018 when it introduced a series of laws that monitored the work of the sector.
Among the areas of oversight state officials in Indiana have introduced is the ability of pharmacists and doctors to offer low=cost alternatives to cash-paying customers. The Supreme Court has backed the role of state and local lawmakers to impact the role of PBMs and the fees they charge.
Hope is Available
The Prescription Hope organization is one of the companies looking to impact the way people fill prescriptions. The group works directly with healthcare providers and pharmaceutical companies to avoid the complexities of ordering through PBM-controlled pharmacies.
The contracts signed by local pharmacies with PBMs limit the amount of information a pharmacist can provide to customers. The cost of lower payment options is not an issue for the organization as they work to remove the impact of PBMs on the average American.
Prescription Hope Builds Momentum in the Fight over Medication Costs
Local and rural pharmacies in Arkansas began to report problems with the contracts they held with Pharmacy Benefit Management companies in 2018. The problems faced by small pharmacies included the inability to receive the rebates needed on medications purchased. Without the rebates offered by PBMs and insurance providers, smaller pharmacies have been driven out of business. JDSupra reports the problem of rural pharmacies and PBMs saw new laws enacted.
Consumers Face Higher Costs
The cost of filling a prescription is no longer set by the provider of your medication. In the last decade, the problem of PBMs and the cost of medications has reached the highest levels of government. The decision to take the case of rural pharmacies to the Supreme Court eased the burden of regulation.
The concern of the Arkansas State Government was twofold. Firstly, the government wanted to maintain access for all residents of the state to affordable medications. Pharmacists had reported being unable to fulfill prescriptions without the use of a PBM, leading them to have no control for pricing. The inability of pharmacists to explain the difference in pricing between a cash price and the cost of buying a drug using health insurance was one of the most controversial subjects.
The Mysterious World of PBMs
The mystery of PBMs has remained in place for the last decade. The problem facing pharmacists and consumers is the lack of access a pharmacist has to the cost of different medications. The work of a PBM includes creating a list of the drugs they have available and their availability. The Maximum Allowable Cost lists are produced by Pharmacy Benefit Management companies and are made available without details. The development of a MAC list is one of the mysteries of PBMs, with no information made available about the calculation of fees.
Prescription Hope Makes Medications Easy and Affordable
The Prescription Hope brand
gives the power back to the people when filling prescriptions. Instead of working through a PBM, the organization provides access to pharmaceutical suppliers to eliminate excess fees. The brand is reducing the cost of healthcare and building a community of professionals. Making life simple for people with a medical issue is one of the aims of the group, with automatic refills handled directly with health providers. By allowing customers to order their medications directly from the distributor, the organization ensures drugs are delivered efficiently to each member
