PBMs are fighting to keep patients and consumers in the dark on prescription drug costs and attempting to reverse a rule created to promote drug price transparency.
The National Community Pharmacists Association (NCPA) has urged the US Department of Health & Human Services (HHS) and the US Department of Justice (DOJ) to support legislation that would make pharmacy benefit managers (PBMs) responsible for disclosing net drug prices they negotiate with pharmaceutical manufacturers.1
Currently, the Pharmaceutical Care Management Association (PCMA) is lobbying against this beneficial legislation. Failure to defend the rule would perpetuate barriers and hidden fees in the prescription drug pricing system. PBMs serve as intermediaries between drug manufacturers, health insurance plans and pharmacies to negotiate prescription drug prices. PBMs typically negotiate concessions below the valued list prices of prescription drugs, which can lead to hidden costs for pharmacists and lower compensation or reimbursement.1,2
Price transparency is vital for the market to work properly. Additionally, there is not enough of it in the prescription drug market. Therefore, there is no way for patients, consumers, taxpayers, employers, insurance plans, or policymakers to make educated choices when they are unaware of the true price of drugs.
A complaint was filed last week with the Supreme Court, where PCMA said the November 2020 ruling would drive up prescription drug costs. The lawsuit targets HHS, the Internal Revenue Service (IRS) and the US Department of Labor. PCMA is challenging a provision of the rule set to take effect in January that would require them to disclose the historical net prices they negotiate with manufacturers.
PCMA claims that the rule threatens to drive up the total drug price ultimately borne by health plans, taxpayers, and consumers by advantaging drug manufacturers in negotiations over price concessions. Armed with information about prices negotiated between manufacturers and PBMs, the NCPA is pushing back against these complaints.
“The PBM lobby represents some of the largest, most profitable, and least transparent corporations in the world,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA.1 “They will spend whatever it takes, and fight for as long as it takes, to maintain the complexity and secrecy on which their profits depend. No one should be surprised that the middlemen profiting most from the lack of transparency are fighting to keep everyone in the dark. This rule shines a light on these deals, and we very strongly urge HHS and the DOJ to defend it.”