There is growing awareness of the problems and pitfalls with Pharmacy Benefit Managers (PBMs) in the United States health care system. Contracted by insurance carriers to negotiate on their behalf with pharmaceutical companies, these ‘middle men’ corporations have quietly become an unavoidable part of our nation’s health care system. Controlling at least 80 percent of drug benefits for over 260 million Americans, PBMs have the power to negotiate drug costs, what drugs will be included on plan formularies, and how those drugs are dispensed. Oftentimes, patients are required to receive drugs through PBM-owned specialty pharmacies.
However, while the role PBMs play in the U.S. health care system is complex and under scrutiny by policymakers and the public, with much of the debate focusing on economics, there is often little discussion of the impact PBMs have on patients.