WHAT IS PBM ABUSE?
Pharmacy Benefit Managers (PBMs) act as the middlemen between health plans, pharmacies and drug manufacturers in the pharmaceutical supply chain. They control 95% of U.S. prescriptions, and their practices drive up costs, limit access and harm patients.
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HOW DO PBMs IMPACT PATIENTS?
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Limited Choice: PBMs may require patients to use specific or PBM-owned pharmacies, a practice known as “patient steering.” This limits access to trusted local pharmacies and delays life-saving medications.
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Restricted Coverage: PBMs decide which drugs are covered, often based on profits rather than care. Patients may be denied their doctor-prescribed treatment or forced to switch to less effective alternatives.
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Higher Costs: PBMs negotiate drug prices and rebates behind closed doors. Instead of passing savings on, they often keep the difference, leaving patients with inflated out-of-pocket costs.
HOW DO PBMs IMPACT PHARMACIES?
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Unfair Reimbursements: PBMs often pay pharmacies below the cost of the medication, forcing many independents to fill prescriptions at a loss.
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Restricted Networks: PBMs steer patients to PBM-owned or preferred pharmacies, cutting traffic to community and rural pharmacies and creating deserts of care.
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Limited Access to Medications: PBM formularies and pricing rules make it difficult for pharmacies to stock certain drugs, reducing patient access and threatening local business.
YOU DESERVE:
TRANSPARENCY. FAIR PRICES.
ACCESSIBLE MEDICATIONS. CHOICE.
FEAR vs. FACT
The mega PBMs frighten employers and legislators with threats of higher costs in the wake of reform. Studies like this one show how detrimental PBM conduct can be, while states like West Virginia are proving that cost SAVINGS can be enjoyed with full transparency, as reported here. Lawsuits are helping uncover the truth as well, as Missouri-based O’Reilly Auto Parts and unions in Michigan are suing PBMs for unfairly raising the cost of insulin.
WHAT NEEDS TO HAPPEN?
Missouri needs PBM reform to protect patients, employers, and communities. By joining the
Missouri Pharmacy Business Council, you add
your voice to a growing coalition demanding transparency, fairness and accountability.
