Demystifying PBMs, Their Role in the Drug Supply Chain

Federal investigations, pharmacy community advocacy, and bipartisan support for reform are all just a few things that have contributed to the uncovering of the country’s largest prescription middlemen, or pharmacy benefit managers (PBMs) as people now know them. While they have become scrutinized for their role in the pharmaceutical supply chain, PBMs were once designed to save patients money and keep pharmacies afloat with reimbursable prescription benefits.

So much has happened between PBMs’ arrival within the supply chain decades ago and the most recent events unveiling them to the world. Amid persistently circulating narratives either supporting or attacking PBMs, it’s important to take a significantly nuanced approach when trying to understand their true function within the industry.

“I think pharmacy and pharmacists have arguably a deserved distrust of PBMs and their integrity in fair dealing with them,” said Antonio Ciaccia, President of 3 Axis Advisors and CEO of 46brooklyn Research. “PBMs say, ‘Hey, we're great to pharmacists.’ I think pharmacists are reasonable in saying that's not the case. That's not me saying that one is right or wrong. It's just that I see the numbers, I see how these relationships work, and it is designed to be frictious. They're not meant to be lovers necessarily; they're meant to be Hatfields and McCoys.”

On the most recent episode of Over the Counter, Ciaccia joined us to dive deep into issues surrounding PBMs, their treatment toward pharmacies, and how they are perceived in the public eye, in light of recent events. With years of expertise into these often-denounced entities—and even some of his own work in uncovering Ohio PBMs—Ciaccia helps us better understand why PBMs are so notable and what how their current perceptions may change in the future.

Stay tuned for weekly podcast episodes on Over the Counter every Thursday afternoon. Check out our previous episode with Luke Turnock, PhD, who discussed the normalization of lifestyle drugs on social media. From testosterone replacement therapy to the increasingly popular weight-loss drugs, he touched on the impacts increased advertising has on social media users.

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