Mary Tipton: 'Pharmacy benefit managers, the intermediaries between drug manufacturers and health insurers... exert enormous control over the prescription drug market while providing little to no value.'
PBMs’ pay-to-play control also boosts medication prices by preventing less expensive alternatives, which have lower rebates, from reaching the market. For instance, PBMs havea generic long-acting insulin, known as insulin glargine, from becoming wildly available despite its incredible potential for American diabetics.
PBMs aren’t the only inflationary culprit in the prescription drug market. The Wall Street Journal recently publishedrevealing how American hospitals are taking advantage of a federal drug discount program called 340B meant to help underserved populations access medications at steep discounts. Hospitals are purchasing these drugs through the program at pennies on the dollar, then turning around and charging patients and health plans full list prices, pocketing the difference.
According to the report, the Cleveland Clinic made $136 million on the program in 2020, and the University of Michigan Medical center made $482 million in 2021, more than its entire net income that year. Hospitals are making billions of dollars that should be going to vulnerable patients in the form of lower drug costs.
While the real reasons for high prescription drug prices are complicated, the solution is simple: Congress should pass legislation that requires dollars collected by middlemen like PBMs and hospitals to pass through to patients in the form of savings at the prescription counter.
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