For years, policymakers have called for more transparency in the prescription drug supply chain. Today, PBMs are not just meeting that challenge, they’re setting the standard. From fundamental changes to their business models to sweeping new reporting requirements enshrined in the Consolidated Appropriations Act (CAA) to a bold commitment that gives patients clearer information about drug costs on TrumpRx, PBMs are providing unprecedented visibility into how prescription drug benefits work and what medications cost.
A New Era of Transparency for PBMs
In recent years, pharmacy benefit managers (PBMs) have come a long way in how they do business, ultimately leading to patients being better informed about their drug coverage and employers knowing how their health care dollars are being spent. The CAA, enacted earlier this year, builds on that progress and now guarantees that PBMs will be the most transparent actors in the supply chain.
Soon, data on every claim, every drug, every contract, and every fee will be easily accessible to employers, unions, and government programs. The sweeping PBM provisions included in the CAA subjects PBMs to enhanced reporting, grants new audit rights to Part D plans, employers, and unions, and orders additional government studies and annual reports on the industry.
But PBMs aren’t stopping there.
New Pledge Supports Transparency in TrumpRx
The Pharmaceutical Care Management Association (PCMA) and ten of its members recently announced a new commitment related to TrumpRx. The ten PBMs will now bring TrumpRx prices into the existing Real Time Benefit Tools (RTBTs) that can be used by doctors and patients . Doctors are able to use RTBT to view patient costs for a range of drugs available to treat a condition, including options that provide lower out-of-pocket costs for the patient, and have a conversation with the patient about the different treatments available.
Patients will also be able to see displayed TrumpRx prices alongside costs available through their pharmacy benefit, which will allow patients to better compare their options and empower them to work with their doctor to choose the one that best meets their needs.
Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz applauded the commitment and noted “that’s the kind of transparency we need to boost competition, drive down costs, and deliver better value for American patients.”
This commitment reflects a belief that patients should have access to clear pricing information, regardless of where the price originates. It also builds on the industry’s longstanding investments in delivering transparent information to patients.
Tools developed by PBMs often allow patients to compare their out-of-pocket costs across pharmacies in their network, so they know exactly what they’ll pay for a drug. They can see their options for ordering a prescription drug – whether at a chain pharmacy, a local independent, or through the mail – and identify opportunities to save money. This helps eliminate surprises at the pharmacy counter and ensures that patients have the information they need to determine where to fill their prescription.
Now, Let’s Shine Similar Light on Other Parts of the Supply Chain
As policymakers look for ways to make health care more affordable, they should ask why other parts of the supply chain are not nearly as transparent as the PBM industry. Prescription drug wholesalers, for example, are receiving new scrutiny about the massive influence they have over nearly every part of the supply chain by buying drugs from manufacturers, then selling and shipping them to pharmacies. Calls are growing for federal and state policymakers to Demand Accountability from Wholesalers Now.