Exploring Alternatives to the Prescription Drug Rebate System
Pharmacy benefit managers (PBMs) stand for lower drug costs and rely on the ability to negotiate with drug companies to bring down costs for employers, labor unions, and patients.

Pharmacy benefit managers (PBMs) stand for lower drug costs and rely on the ability to negotiate with drug companies to bring down costs for employers, labor unions, and patients.
Every policymaker in America, on both sides of the aisle, wants to lower prescription drug costs. There is a basic understanding that drug costs are too high for some patients. How to lower drug costs is equally basic: the drug companies that set the prices should lower those prices. Unfortunately, drug companies have succeeded at muddying the path to achieving this universally shared objective.
Once again, we are reading news reports about the pharmaceutical industry’s efforts to influence public policy and their latest meetings with the new Trump Administration, set against a backdrop of rising list prices and continuous TV advertisements targeting American patients to take ever more expensive drugs. Every day, Americans hear about new pharmaceutical innovations to improve their health and their lives – from personalized medicine to breakthrough treatments for cancer to innovations in weight loss therapies. Make no mistake, this pharmaceutical innovation is a good thing.
Pharmacy benefit managers deliver on their mission every day to expand access to prescription drugs, saving Americans on average $1,040 per person annually. Last month, three leading pharmacy benefit companies pledged to Sen. Bernie Sanders, the chairman of the Senate Committee on Health, Education, Labor and Pensions — ahead of a recent congressional hearing where major drug manufacturer Novo Nordisk testified on how the company chooses to price popular GLP-1 drugs — that they are committed to facilitating access to these drugs, should Novo Nordisk (and other GLP-1 drug manufacturers) decide to lower the price of certain GLP-1s to $100 or less per patient per month for health plan sponsors.
Few issues in health care have received more attention over the past year than the breakthrough weight loss treatments, GLP-1s. The potential for these medications to help millions of Americans is extremely exciting.
Labor Day is an opportunity to remember and commend the integrity, dignity and contributions of America’s workforce. At its core, the mission of pharmacy benefit companies is centered on supporting American workers — by enabling employers and unions in providing healthcare benefits that include access to affordable prescription drugs, PBMs are supporting their employees and members.
A lot of ink has been spilled on the topic of prescription drug prices and how Congress can address out-of-pocket costs for Americans. Unfortunately, much of the narrative has been shaped by incomplete press reports and over-simplified talking points that wrongly point the finger at pharmacy benefit companies (PBMs).
To achieve a more affordable, higher quality future for our health care system, the policy debate cannot ignore the critical perspective of the employers who collectively sponsor health insurance benefits for 86 percent of employees working in the private sector.
With the recent agreement to fund the government through the end of the fiscal year and the decision not to include provisions targeting pharmacy benefit companies, there is an opportunity to think again before misguided legislation is advanced that would do nothing to lower prescription drug costs for patients.
Pharmaceutical Care Management Association (PCMA) members have long advocated for and implemented new programs to achieve a more equitable health care system.