16485: PBM WTF.

 

PhRMA—Pharmaceutical Research and Manufacturers of America^®—sounds the alarm by declaring, “There’s a PBM standing between you and your doctor.”

 

A PBM, incidentally, is a Pharmacy Benefit Manager. NAIC—National Association of Insurance Commissioners—states the following:

 

Pharmacy Benefit Managers (PBMs) are third-party companies that function as intermediaries between insurance providers and pharmaceutical manufacturers. PBMs create formularies, negotiate rebates (discounts paid by a drug manufacturer to a PBM) with manufacturers, process claims, create pharmacy networks, review drug utilization, and occasionally manage mail-order specialty pharmacies.

 

In light of rising health care costs, the role of PBMs are being reviewed due to the cost of prescription drugs and the effects on consumers. The cost of insulin and EpiPens has been the focus of much of the news coverage, with patients being forced to ration medicine when they cannot afford copays.

 

In short, PBMs are key players in deciding which drugs will be covered by which insurance providers, ultimately impacting drug manufacturers, doctors, people, and insurance providers—albeit each in distinct ways.

 

There are clearly conflicting interests between drug manufacturers—ie, Big Pharma—and PBMs. So, it’s not surprising that PhRMA would launch a campaign to discredit the irritating intermediaries.

 

But why stereotype PBMs as angry, old White men with corporate suits and characteristics? Oddly enough, the image seemingly reflects public perceptions of Big Pharma executives.

 

It’s pot calling the kettle, well, White.