In the labyrinthine landscape of the healthcare industry, where multiple players jostle for supremacy, few battles have been as intense and protracted as those between pharmaceutical companies and Pharmacy Benefit Managers (PBMs). This clash of titans isn’t merely a skirmish over market share or profit margins; it’s a struggle for control over the intricate web of drug pricing, distribution, and access. As the dust settles, it becomes increasingly evident that pharmaceutical CEOs are determined to rid themselves of PBMs, and here’s why.
Pharmacy benefit managers (PBMs) and pharmaceutical companies have been locked in a battle over the cost of prescription drugs for years. PBMs, third-party companies that administer prescription drug benefits for health insurers, argue that they are working to reduce drug costs for patients. Pharmaceutical companies, conversely, say that PBMs are using their market power to extract excessive rebates from drugmakers, which are passed on to patients through higher prices.
IN SUMMARY: PBMs are keeping a smaller share of rebates and passing more along to their clients. Instead, PBMs are collecting more revenue through various fees — the same shift the Trump administration envisions — and through a practice called “spread pricing,” according to a Pew analysis.