High Priced Drugs

America’s PBMs are the only member of the prescription drug supply
and payment chain working to reduce high drug costs, improve patient
access, and increase affordability.

PBMs administer prescription drug plans for more than 266 million Americans with health coverage through employers, health insurers, labor unions, Medicare and Medicaid. Using innovative cost-saving tools and technologies, PBMs are working every day on behalf of patients and payers to increase affordability and access to prescription drugs.

RESEARCH SHOWS US

5.4

Prescription drug spending is projected to grow at 5.4% per year between 2021–2023.

6.8

Drug manufacturers increased list prices by an average 6.8% on 857 drugs between January and June 2020.

PBMs have reduced costs and have a return on investment for payers of $10 for every $1 spent on PBM services.

High-Priced Drugs Hurt Patients’ Wallets and Health

High-priced prescription drugs contribute to financial and medication access barriers for patients, with cost being the most cited reason for non-adherence. Poor prescription drug adherence has been shown to result in worse health outcomes and increased health care costs.

 

PBMs: Committed to Helping Patients

The Critical Path Forward: Rx Policies to Reduce Patient Costs, Improve Access

For America’s PBMs, our core mission is to increase access to affordable prescription drugs for all Americans. But more can be done and we stand ready to be part of the solution.

PCMA’s Policy Platform presents straightforward solutions that, taken together, would lower prescription drug costs and make pharmaceutical care even more accessible for all Americans. This policy platform would result in total Federal Savings of $255.5 billion to $398.7 billion over ten years. 

Promotion of Higher-Cost Drugs

Manufacturers promote the use of higher cost drugs using coupons, copay cards, direct-to-consumer advertising, and physician payments.

  • The number of branded drugs that offered coupons rose from 278 in 2012 to 701 in 2018 and the total dollar value of redeemed coupons reached $13 billion nationwide that year. 
  • The prices for brand drugs with coupons are rising 12-13% every year, compared to 7-8% increases for brand drugs without coupons. 
  • Banning copay coupons would lower prescription drug costs by approximately $1.2 billion per year.”

 

Why PBMs?

PBMs increase access and lower Rx costs for 266 million patients with health coverage provided by commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program (FEHBP), state government employee plans, Medicaid plans, and others.

Case Study: How PBMs Save on Insulin

Managing Costs with Increasing Manufacturer Prices

THE PHARMACY BENEFIT PODCAST