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On the heels of the FTC ’s investigation into pharmacy benefit managers for what many regard as anti-competitive business practices, legal pressure is continuing to mount., including California, Ohio and most recently Vermont, have initiated lawsuits against PBM s.
PBMs also argue that their large scale is a necessary counterbalance to the large drug companies and enables them to better negotiate on behalf of their customers. David Joyner, president of CVS Caremark, said in a recent New York Times: “size and scale really matters in order to be able to influence and be able to lower the overall cost of branded pharmaceuticals.
While PBMs present themselves as indispensable allies in managing prescription drug benefits, reality reveals a stark contrast to their promises. One concern is the lack of transparency in pricing and rebates. Employers are kept in the dark about the true costs and savings, making it difficult to assess whether PBMs are delivering on their cost-containment assurances.
The theoretical advantages of partnering with PBMs–cost savings, simplified administration, and data-driven decision-making–frequently fail to materialize. Instead, employers find themselves facing hidden costs, restricted drug choices and pharmacy networks, and overall higher expenses, which starkly contrasts with the PBMs’ purported value proposition., market consolidation means there’s no easy way out.
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