Pharmacy Benefits Managers Under Pressure
Are we beginning to see the decline of pharmacy benefit managers?
Pharmacy-benefit managers, or PBMs, save money for insurance companies and big corporations by limiting patients’ access to life-saving treatments. By limiting treatment options, they achieve billions of dollars in profits. Think of them as the middleman that does the dirty work with little regard for what is really best for the individual patient.
Now, some insurance companies and big employers are having a change of heart about PBMS. Barrons reports that big companies are looking to circumvent PBMS with the Health Transformation Alliance, a coalition of 30 of the country’s biggest employers who want to get more for their health-care dollars. That move comes as one of the biggest pharmacy benefit managers faces a multi-billion dollar lawsuit.
“Express Scripts got knocked for a loop early this year when the company’s largest commercial client, health-insurer Anthem, claimed in a lawsuit that Express Scripts was overcharging it by $3 billion a year,” Barrons reports.
PBMs operate entirely in secret. Even PBM clients can’t access information. Susan Hayes, who works as an auditor of PBM contracts, told USA Today in February, that “auditors aren’t allowed to copy or take pictures of documents when they audit a PBM’s rebate contracts.”