WASHINGTON — The White House is reviewing a proposal that could shake up the system that allows drug makers to offer rebates to pharmacy benefit managers, a shift that some U.S. officials hope could drive down the prices of medicines.
Currently, pharmaceutical companies set list prices for drugs and then offer PBMs (which work for insurers) rebates off list prices if an insurer covers those drugs. Drug manufacturers have alleged that PBMs demand large rebates, forcing them to increase list prices to make sure they can still profit.
Getting rid of rebates, or cutting the link between the rebate amount and the list price, could remove one incentive for high list prices.
Look at history . Drug manufacturers charge what the market will bear . History shows competition drives prices down . With only three PBMs ( Express Scripts , CVS / Caremark , OptumRX ) controlling the vast majority of prescriptions filled – there is no competition . Drug manufacturers take advantage and charge as much as they can .
PBM monopolize and dictate patients to go to certain pharmacies, for example CVS caremark. They restrict a 90 days fill often below cost reimbursement to independent pharmacies. They audit and find minor faults for claw-backs and if you contest, they terminate you off as a provider. They send membership cards with their name only on card, misleading the public that they can only go to their chains. This is false advertisement. They continue to do this driving independent pharmacies out of business. PBM also own part of the 3 big wholesalers . PBM practices should be reviewed, their clout and power are unchecked with no competition. Independent pharmacies are closing every day due to unfair practices by PBM. Any challenges would result in individual pharmacies being terminated from their plan. There is no recourse, they are the final answer to everything. Please help independent pharmacies find justice.