PBMs. Lowering Drug Prices. Protecting Patients.
American families are safer, healthier, and pay less for their
prescription drugs because of the work done by pharmacy
benefit managers.
What is a PBM?
Pharmacy Benefit Managers, or PBMs, are the ones standing up to big drugmakers on behalf of patients, employers, unions, and government programs. Employers hire PBMs to drive down the sky-high prices set by Big Pharma and to ensure patients have access to safe and affordable medicine.
PBMs are lowering drug prices, increasing patient safety, and providing employers with maximum transparency.
Lowering Drug Prices
A PBM is how a $1,000 prescription drug becomes a $10 co-pay.
Forty years ago, generic drugs accounted for less than 20% of prescribed drugs. Today it’s over 90%. Congress passed the Hatch-Waxman Act limiting market exclusivity periods for brand-name drugs and paving the way for far more generic drugs to enter the market.
Once generics become available, PBMs make them accessible by placing them on prescription drug formularies, removing the more expensive brand-name drug.
So, a brand drug with a list price of $1,000 turns into a cheap generic drug, on a formulary, with a $10 copay for patients.
PBMs are the only segment of the drug supply that exist to drive down the cost of medicines. And they are highly effective at delivering savings for America’s employers and patients.
- PBMs reduce drug costs by over $1,000 per person each year for 289 million Americans.
- PBMs will save $557 billion in Medicare Part D over 10 years.
- PBMs reduce overall drug costs by more than $300 billion annually.
PBMs Protecting Patients
PBMs will help prevent 1 billion medication errors over the next ten years.
Every prescription instantaneously undergoes safety and quality checks to identify potential safety concerns, including:
- Dangerous drug-to-drug interactions
- Duplicate prescriptions
- Incorrect or unsafe dosing
- Potential allergic reactions
PBMs Support Employers
For every $1 spent on PBM services, PBMs reduce costs by $10.
Employers, unions, and government programs are not required to hire a PBM, but the vast majority choose to work with PBMs because of the value and savings they deliver for their business and their workforce.
On behalf of America’s employers, PBMs perform valuable services including:
- Negotiating rebates from drug manufacturers and passing 100% of those savings through to the employer.
- Providing complete transparency – drug by drug, claim by claim, pharmacy by pharmacy data.
- Providing clinical services for patients enrolled in employer health plans.
- Processing and adjudicating pharmacy claims on behalf of the employer health plan.
93% of employers are satisfied with the savings on prescription drugs that PBMs are generating.
This year, health care policy research firm, Healthsperien, conducted a survey of more than 1,000 employers. The firms surveyed range from 10 employees or fewer to employers with more than 5,000 employees.
Key findings from the survey include high satisfaction with:
- PBMs Lowering Drug Costs: 93% of employers are satisfied with the savings on prescription drugs that PBMs are generating.
- Transparency: 94% of employers are satisfied with the levels of transparency PBMs provide.
- Prescription Drug Coverage Options: More than nine in 10 employers are satisfied with the range of pharmacy benefit options for employers to choose from.