PBMs

A new data tool from Pioneer Institute reveals that federal drug price controls—intended to reduce out-of-pocket costs for seniors—are instead making many prescription drugs more expensive for Medicare beneficiaries.  

The reality is that non-price factors, including several players, are causing net prices to decline and retail prices to increase. Those players include employers, health plans, and pharmacy benefit managers (PBMs), all of whom have continuously circumvented the system through loopholes and complicated systems of reimbursement that tend to hurt patients

S. 609, a bill that would limit out-of-pocket costs for patients paying for prescription drugs, is a clear step in the right direction. Massachusetts should join 16 other states that have passed similar bills to protect patients.

A new white paper, "Out-of-Pocket Pirates: Pharmacy Benefit Managers (PBMs) and the Confiscation of Copayment Assistance Programs," examines how the way these programs are implemented is having negative impacts on patients living with serious diseases.

Earlier this year, the Center for Health Information and Analysis (CHIA) released its Annual Report on the Performance of the Massachusetts Health Care System for 2020.  The Massachusetts Legislature relies on CHIA data when considering bills to regulate drug costs and prices. The advocacy group Health Care for All reported that CHIA data showed prescription drug spending grew by 7.7 percent in 2020, more than twice the benchmark - but the most reliable data on prescription drugs indicates that spending in 2020 was essentially flat. 

Pioneer Institute Senior Fellows William Smith and Robert Popovian submitted public comments about PBM business practices to the Federal Trade Commission (FTC). Pioneer recommended that PBM discounts be passed along to patients when they are meeting their deductible or coinsurance requirements.