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VIEWPOINT: The need for PBM reform is real

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Recently, the Delaware Business Times published some advice concerning health care costs for employers.

Delaware Pharmacists Society Executive Director Dr. Kim Robbins discusses the significance of reforming the pharmacy benefit managers system.

Kim Robbins

There is one aspect to that piece that should probably be discussed further – namely the role of pharmacy benefit managers, or PBMs.

Pharmacy benefit managers are large corporations that were originally formed to negotiate prescription drug prices between drug manufacturers and health insurance plans with the goal of delivering savings to patients. Over time and after much consolidation, however, PBMs have identified ways to continuously increase their profits from the drug pricing system – diverting cost savings meant for patients into their own hands. 

Additionally, PBMs are responsible for developing pharmacy networks, therefore defining where patients can access their medications as well as how much a pharmacy is paid for the services provided. Essentially, PBMs control virtually every aspect of medication cost and access in the United States.

The Delaware Pharmacists Society, made up of more than 800 pharmacists throughout the state, has seen first hand the ways PBMs have negatively impacted patients, families, businesses, and the health care community. Many of us in the business community as well as those in government are raising questions about the role of PBMs and are actively calling for reform.

On July 20, the Federal Trade Commission issued a statement withdrawing the commission’s previous advocacy for PBMs and stating that the regulatory body is engaged in a major study of PBMs.

Delaware’s Congressional delegation is also working to reform the current PBM system, as U.S. Rep. Lisa Blunt Rochester sponsored the Protecting Patients Against PBM Abuses Act and U.S. Sen. Tom Carper introduced the PBM Oversight Act of 2023 to provide the federal government with more authority to oversee the PBM program.

These are just two pieces of legislation – there are several other efforts in Congress to address the problems with the current PBM system, such as the Patients Before Middlemen Act and the Delinking Revenue from Unfair Gouging Act.

I would encourage all employers to take some time to learn more about the role of PBMs and contact your legislator to encourage them to continue their efforts to reform this program and make health care more affordable for all of us.

Dr. Kim Robbins, RPh, is the executive director of the Delaware Pharmacists Society.


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