Fairly or not, in the blame game for high drug prices, pharmacy benefit managers (PBMs) often come up as the middlemen who make profits but don’t add much value.

The respondents to our 2022 Pharmacy Survey beg to differ.

A strong majority (62%) indicated that PBMs help lower net drug prices. Only a small group (21%) thought antitrust action to break up the dominant PBMs should be considered. An even smaller group (15%) agreed with strengthening the audit rights for employers and government payers.

But these results are not surprising considering that about 38% of the more than 950 respondents to the survey said they work for a PBM.

The survey was distributed online in late June and early through various channels by Managed Healthcare Executive® and our colleagues at Pharmacy Times®.

Of the remaining respondents, 24% said they worked for a payer organization, 21% said they worked for a provider, 9% for a pharmaceutical company and 8% for consultants (the total is more than 100% because a few respondents said their employers were in more than one sector).

The PBM industry is criticized for being opaque and keeping rebates and pricing arrangements secret. About half (49%) of the respondents said they favor imposing transparency rules on PBMs, and sizable minority (44%) favored requiring formulary placement to reflect the total cost of drugs.

And about half (48%) said value-based contracts between payer and drugmakers would slow the growth in drug expenditures, and about the same proportion (47%) said revising benefit design to create incentives to choose the most cost-effective option would help.

Inflation Reduction Act:

All of prescriptions covered under Medicare Part D or Medicare Advantage – are provided by FOR PROFIT INSURANCE COMPANIES and the PBM companies that the major ones are owned by a Insurance Company..

Were not included in the  Inflation Reduction Act… and those entities have since the beginning of Medicare paying for medication – JAN 2006 –

You will not see these two for profit business entities mentioned in the Inflation Reduction Bill…

In the bill, it is stated that as of 2024, premium increases for Medicare Part D & Advantage will be limited to be in align with CPI/COLA – be prepared to see substantial increases in premiums starting Jan 2023

The act limited  out of pocket expenses to $2,000/yr  – be prepared to see a substantial increases in deductibles…  These deductibles a few years ago went from ZERO to close to $500/yr already…

Could we see $2000/yr deductibles starting in 2025, and whoever is sworn in as President Jan 2025 get the blame..?

Could we see 50%-100% increase in premiums for 2023 so pad premiums for premiums increases locked into CPI/COLA starting in 2024 ?