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WHAT IS PBM ABUSE?
Pharmacy Benefit Managers (PBMs) are middlemen in the pharmaceutical supply chain that increase costs for pharmacies and patients, delay necessary treatments and make healthcare less accessible.
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HOW DO PBMs IMPACT PATIENTS?
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PBMs can impose restrictions on patients, such as mandating the use of PBM-approved pharmacies or mandatory mail orders. This can lead to patients being unable to choose their preferred pharmacy or provider, known as "patient steering."
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PBMs can limit medications that are covered, restricting treatment options for patients.
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PBMs negotiate medication costs with manufacturers, which can result in higher prices for patients and greater profits for the PBMs.
HOW DO PBMs IMPACT PHARMACIES?
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PBMs can set reimbursement rates below the actual cost of acquiring medications and dispensing medications, affecting business.
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PBMs can implement restrictive network, steering patients to specific pharmacies and limiting traffic for other pharmacies.
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PBMs can limit treatment options or make certain treatment options unrealistic for pharmacies to carry, limiting options that can be provided to patients, ultimately hurting business.
YOU DESERVE:
TRANSPARENCY, FAIR PRICES, ACCESSIBLE MEDS AND CHOICE.
HOW ARE PBMs POSSIBLE?
PBMs emerged to act as a middleman to manage prescription drug benefits for health insurance plans. However, their lack of transparency and pricing practices has had a negative impact on pharmacies and patients.
WHAT NEEDS TO HAPPEN?
Stop PBMs before healthcare becomes more and more inaccessible. Regulatory reforms, competition promotion, consumer advocacy, transparency legislation, and collaboration between healthcare providers are steps we need to take.
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