AMA Finds Competition Decline Among Drug Middlemen
American Medical Association, September 12, 2023
“The effects of less competition and more vertical integration in the PBM industry deserve regulatory scrutiny as a check against anticompetitive business practices that harm patients by raising drug prices, lowering quality, reducing choice and stifling innovation,” said AMA President Jesse M. Ehrenfeld, M.D., M.P.H. “As momentum grows for PBM reform in Congress, the AMA continues to lend its support to bipartisan bills that help promote greater transparency and oversight of PBM policies and practices to ensure prescription drugs are affordable and accessible.”
Generic Drugs Should be Cheap, but Insurers are Charging Thousands of Dollars for Them
The Wall Street Journal, September 11, 2023
“Someone in the middle of that transaction is making a lot of money, and they’re doing it at the detriment of the consumers,” said Stacie Dusetzina, a health policy professor at Vanderbilt University School of Medicine who studies drug costs.
National Alliance Guideline Identifies Key PBM Concerns for Health Plan Purchasers
American Journal of Managed Care, reporting on the National Alliance of Healthcare Purchaser Coalitions, September 7, 2023
“PBMs shouldn’t have the upper hand in negotiations just because they understand the industry better, especially since it is the employers who have the fiduciary responsibility for their pharmacy benefit,” said Cora Opsah, director of the 32BJ Health Fund and an advisory board member for A Playbook for Employers – Addressing Pharmacy Benefit Management Misalignment, a product of the National Alliance of Healthcare Purchaser Coalitions.
“At its core, the existing business model is fundamentally flawed. It does not deliver high value for purchasers, and it clearly does not deliver high value for patients. And it has strong biases towards higher cost, higher rebate activities…It permeates the entire way the PBM industry is managing this core benefit for employees and their families, and for purchasers. We can do better, and we need to change how we buy if we want to change how it operates,” said Mike Thompson, CEO of the National Alliance of Healthcare Purchaser Coalitions.
