The increasingly powerful role that pharmacy benefit managers play in the prices and availability of prescription drugs is one that merits careful scrutiny from regulators, says an AMA Council on Medical Service report whose recommendations were adopted at the 2019 AMA Annual Meeting in Chicago.
“It’s time to pull back the curtain on pharmacy benefit managers and how their practices negatively impact patients. How is it that PBMs and health plans profit from negotiated discounts on prescription drugs, while patients pay co-pays based on high drug list prices that even the plans themselves are not paying?” said Russell Kridel, MD, a member of the AMA Board of Trustees. “Because of market concentration and lack of transparency, patients and physicians are essentially powerless in the face of PBM pricing and coverage decisions.”
My latest for the AMA. The whole shebang.