America’s pharmacy benefit managers (PBMs) are dedicated to controlling drug costs by encouraging competition among drug manufacturers and pharmacies and incentivizing consumers to take the most costeffective, clinically appropriate medications. PBMs facilitate patient pharmacy care management and provide real-time information to physicians and patients so they know, when a drug is prescribed, whether it is on the formulary and the patient’s cost-sharing obligation. PBMs uniquely have the expertise, tools, and data to ensure that pharmacies can dispense a patient’s drug, determine her cost-sharing, and know what the pharmacy will be paid, in real-time as the patient stands at the pharmacy counter.
One of the most important functions PBMs perform is negotiating price concessions with drug manufacturers to lower costs for consumers.
As part of an overall plan to address prescription drug spending, the Administration is advancing a proposed rule to change the use of PBM-negotiated price concessions —rebates— for Medicare Part D plans and Medicaid managed care organizations. The Administration is proposing to require the savings be used for a small minority of Medicare beneficiaries to lower their cost-sharing at the pharmacy counter, rather than to help all beneficiaries through lower monthly premiums. The proposed rule does not address drug prices set by drug manufacturers.
The Congressional Budget Office recently agreed with government actuaries that the proposed rule will increase premiums for Medicare beneficiaries and impact taxpayers through significantly higher spending in the programs. A number of diverse organizations, from patient groups to the business community, have expressed opposition to the proposal.
If a new system for applying rebates is to work, it must allow PBMs to do what they do best — removing PBMs from administering negotiated savings would create significant disruption for beneficiaries and pharmacies. Only PBMs have the technical capability, data and infrastructure to administer Medicare and Medicaid drug benefits, even if savings are applied at the pharmacy counter.
Research
Impact of Medicare Part D Drug Manufacturer Rebates at the Point-of-Sale
November 18, 2020
A new report by Milliman shows that over the 10-year period 2022-2031, if all manufacturer rebates were reflected at the...
National Survey of Seniors Regarding the Medicare Part D Prescription Drug Benefit
March 18, 2019
See topline points from the “National Survey of Seniors Regarding the Medicare Part D Prescription Drug Benefit”...
February 26, 2019
Increasing Drug List Prices Show No Correlation with Change in Rebates (2012–2017) View the Infographic Major Findings: Increasing list prices...
PCMA Comments on Administration’s Blueprint on Drug Pricing
July 16, 2018
Click here to read PCMA’s comments on the Blueprint...
OP-Ed’s & Press Releases
OP-Ed’s
January 27, 2021
The new Biden administration has started off strong, taking a thoughtful approach to any number of critical health care issues...
October 12, 2020
As the world responds to the COVID-19 pandemic, the sheer amount of investment going into efforts to come up with...
Press Releases
PCMA Statement on the ‘Counteroffer’ by Drug Companies to the Administration
August 26, 2020
(Washington, D.C.) — Pharmaceutical Care Management Association (PCMA) President and CEO JC Scott issued the following statement on the reported...
PCMA Statement on Medicare Part D Premiums
July 29, 2020
(Washington, D.C.) — Pharmaceutical Care Management Association (PCMA) President and CEO JC Scott issued the following statement on the Administration’s announcement...
July 28, 2020
(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) is announcing the launch of a TV and digital advertising campaign...
PCMA Statement on Administration’s Executive Order on Prescription Drug Pricing
July 24, 2020
(Washington, D.C.) — Pharmaceutical Care Management Association (PCMA) President and CEO JC Scott issued the following statement on the Administration’s...

August 14, 2019
(Washington, D.C.) — The Pharmaceutical Care Management Association (PCMA) President and CEO JC Scott issued the following statement on the Government Accountability...
Additional Resources
Morning Consult: Congress Should Act Quickly to Permanently Repeal the Rebate Rule
April 12, 2021
While Congress and the Biden administration, as well as stakeholders across the prescription drug supply chain, examine policy options for...
Rebate Rule Effective Date Postponed to 2023
January 30, 2021
(Washington, D.C.) — In response to litigation brought by the Pharmaceutical Care Management Association (PCMA) challenging the Medicare Part D rebate...
PCMA Statement on Administration’s Executive Order on Prescription Drug Pricing
July 24, 2020
(Washington, D.C.) — Pharmaceutical Care Management Association (PCMA) President and CEO JC Scott issued the following statement on the Administration’s...