Pharmacy Benefit Managers (PBMs) are companies hired by health insurers to manage prescription drug programs. But, as middlemen on the prescription drug supply chain who develop formularies, PBM’s have used their position as price negotiators to keep all savings for themselves! 

The three largest PBMs alone processed 80% of the prescriptions filled in the United States. Last year they made nearly half of a trillion dollars doing it – without providing any benefit to patients.  

PBMs influence prescription drug prices by:  

• Acting as intermediaries between insurers, drugmakers, and pharmacies.   

• Negotiating discounts and rebates from drugmakers in exchange for preferred placement of drugs on insurers’ formularies.   

• Setting patient copayment amounts for and determining which drugs are covered by insurers.   

The ACR supports legislation to increase transparency and reform the operations of PBMs to curtail their impact on out-of-pocket prescription costs.  

Legislation like the PBM Reform Act (S. 1339) would pull back the curtain on the billions of dollars the healthcare system is losing to PBMs and how they impact high out-of-pocket costs. This legislation also includes step therapy guardrails put forth in the Safe Step Act which would bring patient-centered reform to PBM’s and their financial relationship to the formulary decisions which drive step therapy. 

Act now to let Congress know the that making PBMs more transparent would be an important step to lower towards lowering the prices of prescription drugs! The ACR’s Legislative Action Center will allow you to contact your members of Congress with just a few clicks. Take a moment to send your letter today!