THE STORY OF PHARMACY BENEFIT MANAGERS THE MYSTERY OF THE RISING DRUG PRICES
Once upon a time, in a land filled with pharmacies and people needing medicine, there was a big problem with “Pharmacy Benefit Managers” or PBMs. These PBMs were supposed to help people get their medicine at fair prices, but things didn’t work out that way.
Pharmacies, especially the small ones, felt they had no choice but to sign contracts with the big PBMs, even if the deals were bad. They complained about getting paid less and having money taken back by PBMs for no apparent reason. Many small pharmacies had to close because they couldn’t keep up.
One day, the Federal Trade Commission (FTC), which makes sure big businesses play fairly,
For example, Rite Aid, a big pharmacy chain,
announced it was closing hundreds of stores because it couldn’t compete. This was especially bad for people in small towns without many other places to get medicine.
noticed something strange. They saw that a few big companies were taking over many parts of the healthcare world. These companies owned pharmacies, doctors’ offices, and insurance companies. This made it hard for smaller pharmacies to compete and keep prices low. The FTC decided to investigate these PBMs and discovered that three giant PBMs — CVS Caremark, Express Scripts, and OptumRx — controlled almost 80% of all medicine transactions in the country! They decided which medicines were allowed, which
The FTC found out that the big PBMs were paying more money to their own pharmacies than they were paying to other pharmacies. This was unfair and helped the big companies make a lot of extra money.
Because of these unfair practices, the Attorney General of Ohio, Dave Yost, decided to sue Express Scripts to try and stop them from breaking the rules. The PBMs’ group, PCMA, said the FTC’s report was not accurate and didn’t show
pharmacies could be part of their network, and how much they would pay pharmacies for giving out medicine. This system was very confusing and unfair.
all the good PBMs do.
The FTC also discovered that PBMs were making deals with drug companies to keep cheaper, generic drugs off the list of approved medicines. This meant people had to pay more for brand-name drugs when they could have saved money with generics. The FTC’s leader, Lina Khan, said some PBMs were not cooperating with the investigation. They were slow to respond and made it hard for the FTC to do their job. The FTC warned that they would take them to court if the PBMs didn’t cooperate. In the end, the FTC’s report shows that the big PBMs were making it harder for people to get affordable medicine and were hurting small pharmacies. They had too much power and were not using it fairly. The FTC promised to keep investigating and make sure everyone could get their medicine at a fair price.
The FTC shared what they found in a report. They said that because these PBMs were so big and controlled so much, they might be making drug prices higher and hurting small pharmacies. Many people found it hard to afford their medicines. Almost three out of 10 people said they sometimes skipped their medicine because it cost too much. The PBMs said they were doing a good job and saving people money. JC Scott, the president of a group that supports PBMs, said the FTC wasn’t being fair and had already made up their minds before looking at all the facts. Many small pharmacies didn’t agree with the PBMs. They felt like the PBMs were making it hard for them to stay in business. Rep. Buddy Carter, who used to be a pharmacist, was happy the FTC was looking into the PBMs. He said it was time to break up these big companies to help small pharmacies and their communities.
And so, the story continues, with the hope that one day, everyone will have the medicine they need without breaking the bank.
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