PCMA Policy Forum Highlights Indispensable Value of Savings Secured by Pharmacy Benefit Companies

Speakers Discuss Pharmacy Benefit Company Innovations, Importance of Protecting Cost Saving Role, and Solutions to Improve Affordability

In case you missed it, the Pharmaceutical Care Management Association (PCMA) held its annual policy forum yesterday, April 25, 2023, where speakers discussed solutions put forward in PCMA’s Affordable Future policy platform, which focuses on increasing competition to bolster the private market, providing clinicians with data and tools to enhance patient care, and supporting and protecting patients.

JC Scott, president and CEO of PCMA, kicked off the policy forum with opening remarks on the critical value of pharmacy benefit companies and the industry’s commitment to working with policymakers and members of the supply chain to improve affordability for patients. He said:

“I hope you will leave today’s session with new insights on what is happening in the public policy debate on drug pricing and with a better understanding of how pharmacy benefit companies are addressing health care costs, improving health outcomes through their clinical programs, working to provide greater amounts of information to patients, prescribers, employers, and health plan sponsors, as well as the evolution and nature of the pharmacy benefit market that today includes 73 full-service pharmacy benefit companies along with many other new, disruptive models competing with each other to provide high quality services to clients.”

View new PCMA Infographic on PBM Marketplace Competition: The PBM Marketplace Continues to Evolve

Scott also discussed misguided legislation targeting pharmacy benefit companies, saying:

“What’s unfortunate is that all the recent congressional hearings and mark-ups are based on a foundation that fundamentally misconstrues the work pharmacy benefit companies do on behalf of small and large employers, public programs like Medicare Part D, and ultimately 275 million Americans to access affordable prescription drugs and help achieve better health outcomes.

“Despite all the rhetoric and all the focus in Washington on our industry, our private market system is actually working pretty well for the vast majority of patients. Largely speaking, the negotiations that take place between PBMs and drug makers do indeed serve to lower costs for health plan sponsors, create better access for patients, and as a result, lead to more uptake of pharmaceutical products and support for innovation.

“But so much of what’s actually working in terms of access to prescription drugs often gets lost in the political debate. Outlier situations make the headlines, not the mundane news of someone getting their medicine seamlessly, paying what they expected and taking it as prescribed. While we should absolutely focus on ensuring fewer patients fall through the cracks when it comes to affordability and access, we can’t lose sight of the fact that our system is working for so many others. Because if we do lose sight of that reality, we run the risk of advancing legislation and regulation that undermines the health care system instead of improving it.”

See below more highlights from the policy forum.

Lisa Smith, Chief of Operations, OptumRx shared how pharmacy benefit companies are committed to improving patient affordability and transparency. She said:

“There are two things I wanted to hit related to price transparency and affordability for consumers and how that impacts providers…We would love to see aligned incentives across this whole… industry and affordability is essential. Providers really want visibility at the point of prescription…so you’ll hear me talk about PreCheck MyScript which is the name for our [OptumRx] real time benefit checker, other PBMs have real time benefit check as well…It’s really important to [the] patient’s health and these real time benefit checkers make a huge difference in that whole process…

“There are within PreCheck MyScript, a couple of things that the doc can see. They can see the coverage, they can see the price, they can see if they’re clinically appropriate lower cost alternatives, which can be super helpful for the patient. They can see what pharmacies the person can access and that are in network which is also really helpful, if home delivery is an option or nearby retail pharmacies. Both of those are important questions that the doctor wants to be in the position to ask.”

Christine Gilroy, Chief Medical Officer, Express Scripts explained a few of the ways pharmacy benefit companies help the plan sponsors who hire them secure the best pharmacy benefits.

“PBMs are assisting our clients, both health insurance plans and employers in navigating across each of these different components of a pharmacy benefit. We’re consulting with them around their benefit design and making recommendations and providing very direct feedback in terms of how their benefit is structured in supporting the values and outcomes they hope to get and have a pharmacy benefit support for their members. We also provide support around drug management, this is much more traditional, so this is where we’re running a pharmacy and therapeutics committee with lots of outside, independent advisers and getting clinical advice on the right drugs, the best drugs, the most important drugs to have available in the formulary and we’re also putting in clinical guidelines to help our clients navigate where there’s an opportunity, to make sure that a higher value or more affordable drug is placed in front of the member or provider.”

Scott Gottlieb, M.D., Former United States Commissioner, U.S. Food & Drug Administration elucidated how the American biosimilar market has become more successful and helps secure savings. He said:

“…I think what you’ve seen is a robust market taking shape where there’s multiple entrants. There has been biosimilar launches that have failed, but there’s been a lot that have been successful. I think the companies in this space have figured out how to sell a biosimilar. The price savings that you’re seeing are substantial.”

Learn more about public policy solutions that would promote competition in the prescription drug market and effectively lower prices for patients HERE.

Learn more about how pharmacy benefit companies are helping patients HERE.


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. Learn more at www.pcmanet.org