Lowering Patient Costs Leads to More Accessible and Affordable Prescription Drugs
More than 92% of prescriptions cost patients less than $20 at the pharmacy counter; however, over half of insured adults under 65 are worried about affording their prescription drugs. Many of these challenges result from exposure to high list prices that drug companies alone set and raise. For example, from 2008 to 2021, the median list price for a year’s supply of a new brand name drug increased from $2,000 to $180,000. Exorbitant list prices make prescription drugs less affordable for patients, and those impacted are less likely to get on and stay on their medications.
PBMs are not waiting for government interventions or unnecessary mandates to innovate and adapt to changing market conditions to help patients.
PBM Innovations
Putting Patients at the Center
PBMs are working with employers, unions, and other health plan sponsors to offer innovative programs that reduce out-of-pocket costs and help patients affordably access their prescriptions. Below are five important ways that PBMs are innovating to improve affordable access:
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Lowering Out-of-Pocket Costs for Common Drugs
PBMs are working to limit patient costs for common drugs, in some cases bringing that down to $0. They are also offering programs to employers to redesign benefits to cover certain preventive drugs and services at no cost, even before a patient has met their deductible.
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Using Technology to Provide Actionable Information on Drug Costs
Offering patients more information about their pharmacy options and out-of-pocket drug costs empowers them to make decisions. PBMs are offering new tools that help patients see the cost of a medication, the lowest cost way they can access it, and whether there are alternatives that may have lower out-of-pocket costs.
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Driving the Use of Generic Drugs and Biosimilars
PBMs work closely with employers and other plan sponsors to create formularies that incentivize the use of generics and biosimilars, which generally place these drugs on preferred tiers and have lower out-of-pocket costs for patients. In 2022, more than 90% of prescription drugs filled were generics or biosimilars, helping to lower costs for patients. In fact, the average out-of-pocket (OOP) cost for a generic prescription for a commercially insured patient dropped to $5.35 in 2023, compared to $6.21 in 2018.
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Partnering with Manufacturers to Lower Patient Costs at the Pharmacy Counter
To address the growing expense of prescription drugs for patients, PBMs are connecting patients with financial assistance programs. Many PBMs employ patient advocates to help with this work, and others leverage technology that links patients with support offered through grants, manufacturer coupons, copay cards, and nonprofit organizations.
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Offering Discount Cards to Expand Affordability
In some situations, a patient’s pharmacy benefit does not cover certain prescription drugs. PBMs are addressing this challenge by offering copay assistance cards to save on chronic condition medications. Additionally, some PBMs are launching creative discount programs that provide substantial savings on noncovered and even over-the-counter drugs.
These innovative programs, along with many others launched by PBMs, are helping patients access the drugs they need and supporting plan sponsors as they tackle high drug costs. The work to lower drug costs and increase affordable access requires the ability to constantly innovate and adapt to changing market conditions. Policymakers should consider recent changes in the industry when exploring potential legislation that would hinder market innovations.
This is the first post in PCMA’s PBM Innovation Project series, highlighting how PBMs are putting patients first and responding to market demands.
Read more about these innovative programs HERE.
Explore the full PBM Innovation Project 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.
