Commentary published in the Journal of Managed Care + Specialty Pharmacy (JMCP) by Susan A. Cantrell, MHL, RPh, CAE, CEO of Academy of Managed Care Pharmacy (AMCP) defends the critical role of pharmacy benefit managers (PBMs), and cautions that legislation narrowly targeting PBMs could increase prescription drug costs.

Cantrell writes:

“The tenor of the discussion around PBMs has reached an unconstructive point, with PBMs cast as solely responsible for high prescription prices. Overall, although several legislative efforts are well intentioned, they could ultimately raise overall plan costs by removing or limiting key tools at PBMs’ disposal to negotiate with manufacturers and encourage the use of cost-effective treatments.”

See the full JMCP commentary from Susan Cantrell HERE.

Cantrell also explains the critical role of PBMs:

“The PBM industry emerged and grew out of the need to help facilitate patient access to medication at an affordable cost. Early PBMs arose from a need to adjudicate claims, a service still provided by the PBM industry. However, the industry has evolved significantly since its founding, with PBMs now providing a variety of clinical, financial, and operational services.

“PBMs employ a series of tools and perform various services toward that larger effort. These include formulary design, utilization management, analytics, price negotiation, clinical programs, and other services.” 

While big drug companies, and other self-interests, continue to drive a narrative that PBMs drive up prescription drug prices, the truth is that Big Pharma alone sets the price:

“PBMs do not set list prices for pharmaceuticals; this is the purview of pharmaceutical manufacturers. PBMs work to lower the price health plans pay for prescription drugs by negotiating rebates with drug manufacturers; their collective purchasing power is key when compared with single health plans. PBMs then pass through the rebates to the plan sponsors. In some cases, depending on contractual terms, PBMs may retain a portion of the rebates as a part of their compensation. Although this is where much of the “middleman” criticism comes from, limiting or eliminating this compensation would likely have an adverse effect, disincentivizing PBMs from negotiating the largest possible discounts on drug prices.”

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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.