June 21, 2024
Payers | Tea Leaves
  • The issue of high prescription drug costs in America extends beyond the commonly blamed entities like drug companies and insurers. Pharmacy Benefit Managers (PBMs), often overlooked but immensely influential, play a pivotal role. These middlemen, controlled by giants like CVS Health, Cigna, and UnitedHealth Group, oversee drug prescriptions for over 200 million Americans. Their mandate ostensibly includes cost reduction through negotiations with drug manufacturers and pharmacies. However, investigations reveal a different reality: PBMs frequently increase costs by steering patients towards more expensive drugs, imposing hefty markups, and pocketing substantial fees from both sides of transactions. Their opacity and complex operations exacerbate the problem, affecting nearly all Americans through inflated insurance premiums and taxes. Despite claims of saving billions, their practices often prioritize profit over patient affordability and health care system efficiency, prompting scrutiny and calls for reform from lawmakers and regulators alike. (Article here)