Pharmaceutical manufacturers have voiced concerns that pharmacy middlemen, known as pharmacy benefit managers (PBMs), are changing their profit models in ways that may negatively impact patients. These middlemen are moving away from rebates and instead, relying on fees for their revenue. Furthermore, they are steering patients towards pharmacies that they own.
A research study funded by the Pharmaceutical Research and Manufacturers of America (PhRMA) has shed light on these changing business models. The intention is to ensure that policymakers consider these shifts when formulating legislation or taking other actions. Robert Zirkelbach, the executive vice president of public affairs and strategic initiatives at PhRMA, emphasized the need to go beyond focusing solely on rebates in addressing concerns related to the pharmacy benefit management industry.
Historically, the practices of PBMs have faced criticism from various stakeholders. However, much of this criticism has centered around the rebate system. Now, attention is being drawn to the fact that PBMs are increasingly relying on fees as a source of profit. This shift has implications for both the pharmacy industry and patients.
Pharmacy owners may find themselves in a challenging position as PBMs push patients towards their own pharmacies. This could potentially impact the competitiveness and viability of independent pharmacies. Patients, on the other hand, may find their choices limited to the pharmacies owned by the PBM.
It is important for policymakers to closely examine these evolving profit models of pharmacy middlemen to ensure fair and transparent practices that prioritize patient access and affordability. By considering the influence of fees and the push towards PBM-owned pharmacies, policymakers can work towards creating a more equitable and patient-centered healthcare system.
Definitions:
– Pharmacy Benefit Managers (PBMs): Intermediaries between drug manufacturers, pharmacies, and health insurers. They negotiate prescription drug prices, manage formularies, process claims, and administer drug benefit programs.
– Rebates: Payments made by drug manufacturers to PBMs as a discount or incentive for preferential placement of their products.
Sources:
– Research study funded by the Pharmaceutical Research and Manufacturers of America (PhRMA).
