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.  

The ACR applauds Congress for recent landmark reforms to increase transparency and reform the business practices of PBMs within Medicare and Medicaid as a first step to lowering prescription drug prices. Now, it is crucial that Congress acts to regulate the actions of PBMs within commercial insurance plans.

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.   

Act now to let Congress know that reforming PBMs in the commercial market is necessary to lower 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!