Rising Drug Costs: Are Pharmacy Benefits Managers to Blame?

For many Americans, the rising tide of prescription drug prices seems like an unstoppable force, threatening to drown family budgets and access to health care. While pharmaceutical companies often shoulder the brunt of public blame, the web of influences on drug costs is much more intricate. Today, we shine a spotlight on a critical, but usually hidden, player in this system: pharmacy benefit managers, or PBMs.

Rebecca Robbins, a leading investigative reporter specializing in pharmaceuticals for the New York Times, takes us on a deep dive into the world of PBMs. We explore their role as middlemen between drugmakers, insurers, pharmacies and, ultimately, patients. This complex dance can have a significant impact on how much you pay for your medications.

Our investigation will delve into how PBMs negotiate drug prices, formulate coverage lists (which determine which drugs are covered by insurance), and manage pharmacy networks. We will also explore the potential conflicts of interest that can arise within this system and how these practices may contribute to the rising cost of prescription drugs.

By understanding the role of PBMs, we can gain a more complete picture of the factors that determine drug affordability. This knowledge is critical as policymakers and health care stakeholders work to create a more sustainable and equitable prescription drug market for all Americans.