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NAM Campaign: Reform PBMs to Help Employers, Workers

Pharmacy benefit managers—companies that were first established to manage the cost of prescription drugs—are contributing to soaring health care costs and driving up the price of medications. These entities cannot go unchecked, and Congress must act, an NAM ad campaign launched Thursday is advocating.

What’s going on: The campaign, which includes both TV and digital ads, calls out PBMs—“middlemen owned by large health insurers”—for pocketing sizeable discounts from drug manufacturers rather than passing on the discounts or rebates to workers or employers.

  • “America’s manufacturing workforce has struggled with skyrocketing health care costs driven by insurer-owned PBM middlemen for far too long,” said NAM President and CEO Jay Timmons.
  • “Manufacturers are committed to providing quality health care benefits to our employees, so we need reforms to stop insurer-owned PBMs from keeping discounts and driving up prescription drug costs.”

Why it’s important: PBMs emerged in the late 1960s as a way of helping insurance companies and employers contain spending on prescription medications—but their business model has evolved significantly in the past half-century.

  • Now just a few PBMs—subsidiaries of bigger health care firms—control up to 89% of the prescription drug market and operate with limited federal oversight.
  • And they exert even more control in the industry by steering business toward specific pharmacy networks, frequently ones owned by their parent companies.

Congressional moves: Congress is considering various legislative solutions to address PBM rebate, fee and payment structures.

  • Policymakers are focusing on providing increased transparency so that employers and patients alike have more visibility into the health care supply chain and PBMs’ practices—all in an effort to lower costs.

The last word: “Manufacturers support both reforming the pharmacy benefit manager model and looking more deeply into pharmaceutical pass-through savings,” said NAM Vice President of Infrastructure, Innovation and Human Resources Policy Robyn Boerstling. “The current incentive setup must be changed for employer health plan sponsors and consumers to see savings at the pharmacy.”

NAM in the news: POLITICO’s Influence newsletter highlighted the NAM’s campaign.

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