Many patient and provider organizations are concerned about pharmacy benefit managers (PBMs) and their impact on healthcare costs and patient access to medicines.
Today, three PBMs (CVS Caremark, Express Scripts, and Optum Rx) control over 80% of the prescription drug marketplace and create policies that incentivize higher-cost medications. These vertically integrated companies take decision-making away from patients, physicians, and community pharmacists.
Legislative action to address PBM issues should:
- Ensure the cost-savings from rebates and discounts are shared directly with patients at the point-of-sale
- Create a PBM revenue system not tied to medicine prices.
- Demand PBM data transparency.
The American Senior Alliance joined 18 patient and provider advocacy organizations to urge Senator Bill Cassidy to champion comprehensive PBM reform in an end-of-year package, prioritizing sharing rebates directly with patients and delinks PBM fees from the price of the drug in both the commercial and government programs space. Read our joint letter here (link to attached letter).