What exactly are pharmacy benefit managers (PBMs) and why are policymakers hearing so much about them now?
That was one of the questions answered as PCMA convened a panel of experts on Capitol Hill last week to discuss the role of PBMs in the health care system.
JC Scott, president and CEO, PCMA, welcomed Congressional staffers and noted that Americans are facing an affordability challenge due to high list prices set by drug companies and unprecedented demand for new drugs. He highlighted how PBMs have responded to evolving consumer demands by launching new innovations that lower out-of-pocket costs, help more patients access the drugs they need, and strengthen the pharmacy market.
Scott emphasized the importance of every health plan sponsor having the ability to choose what best fits their needs and urged Congress to protect that flexibility, saying:
“No plan sponsor is required to hire a PBM. It’s a free and open market. Plan sponsors choose first whether to even contract with a PBM and then they decide the services that will give them the best ability to provide the benefits.”
Former Congressman Ryan Costello asked the experts to discuss the value of a PBM. Panelists described how PBMs secure savings for employers, patients, and taxpayers, enable better health outcomes for patients, and provide employers with a wide range of choices for quality prescription drug coverage. This work translates into real savings – helping patients and employers save $1,154 per person every year.
Alex Keeton, VP Pharmacy Care Services, UnitedHealth Group, described the important role that PBMs play in making drugs affordable and accessible for patients:
“We want drug companies to make investments and bring new cures and therapeutics to market… PBMs act as the counterweight to drug companies’ pricing power, to bring them to the table and say we want to provide access to your medicines but they need to be affordable.”
Panelists then turned to the role that pharmacies play in a patient-centered health care system. Brad Kogen, AVP Pharmacy Network Management, Prime Therapeutics, spoke about the importance of retail pharmacies and how valuable they are for patients to have a range of choices to access their prescriptions. Kogen discussed the quality component and standards in building networks, which helps provide patients with a higher quality, lower cost pharmacy experience. He also discussed the value of specialty pharmacies, especially for patients with complex conditions.
Vertical integration and competition in the PBM market was another area of inquiry from staffers. Angela Banks, VP Policy, PCMA, described the rigorous process that PBMs must go through to secure new business, competing with the more than 70 full-service PBMs in the market and matching the requirements set forth by the employer, labor union, or health plan. The panel agreed that the competition in the marketplace is a catalyst for better serving employers and patients, with PBMs focused on leveraging everything they can to improve the health care system.
Those interested in learning more about PBMs are welcome to reach out to Lucia Lebens (llebens@pcmanet.org), SVP Federal Affairs and Political Strategy, PCMA.
To learn more about how PBMs work, click HERE.
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PCMA is the national association representing America’s pharmacy benefit companies. Pharmacy benefit companies are working every day to secure savings, enable better health outcomes, and support access to quality prescription drug coverage for more than 275 million patients.
