The recent opinion piece (“Money or medicine? Our state’s most vulnerable shouldn’t have to choose” May 20) is an inappropriate attack on pharmacy benefit managers in a time when everyone across the health care industry should be coming together for patients. That’s exactly what pharmacy benefit managers are doing: partnering with groups representing doctors, hospitals, insurers and drug manufacturers to work together for patients.
Pharmacy benefit managers are hired by health plans, unions, individual employers and public programs to reduce prescription drug costs and increase access to affordable medications for patients in Utah and nationwide. In Utah, pharmacy benefit managers will save over $9 billion on prescription drugs over 10 years.
While drug manufacturers alone set drug prices, pharmacy benefit managers negotiate rebates with drugmakers, which is a key tool to reduce prescription drug costs for consumers. These savings are used either to maintain lower premiums for all consumers in a health plan, or to keep down the cost that consumers pay at the counter. Importantly, any notion that PBMs are padding their bottom line through rebates is false.
For years, drug manufacturers have called for mandatory point-of-sale rebates. However, it has long been established that mandating that rebates be calculated at the point-of-sale will drastically raise premiums on Medicare beneficiaries.
Unfortunately, the op-ed’s author cherry-picks information from a Congressional Budget Office report, when in fact the report clearly shows that mandatory point-of-sale rebates in Medicare’s prescription drug program will increase spending by $170 million. It should be noted that in the commercial market, pharmacy benefit managers offer health plan sponsors the option of point-of-sale rebates. But an across the board mandate of this policy would only raise drug costs. Pharmacy benefit managers’ priority is to ensure patients maintain access to the medicines they need and at a price they can afford.