Consumer advocate groups are already engaged in an arms race of sorts, for what will likely devolve into a pitched battle in the 2018 legislative session against insurers and pharmacy benefit managers. Across the country, the inflated cost of prescription drugs has become a flashpoint in the ongoing national conversation about health care costs.
Get ready for pharmacy-choice legislation to be proposed later this fall that aims to increase competition and lower prices for consumers by cutting out the middleman: the Pharmacy Benefit Manager.
Pharmacy Benefit Managers (PBMs) are third-party administrators of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health BenefitsProgram, and state government employee plans. But consumer advocates say that PBM’s can also be described another way: as profiteering middlemen who unnecessarily drive up the cost of prescription medication for unsuspecting consumers.
Naturally, insurance companies use an altogether different description for PBM’s, saying they provide programs and services designed to help maximize drug effectiveness and contain drug expenditures by appropriately influencing the behaviors of prescribing physicians, pharmacists and members.
But a spate of recent news coverage has given PBM programs a black eye, being accused of exerting too much control, or repeatedly overcharging customers:
In Washington, President Donald Trump has repeatedly complained about high drug prices, saying in January that they are “astronomical.” It’s unclear what the administration will do about them.
These horror stories, coupled with the rising cost of prescription meds, will continue to drive the narrative heading into committee weeks this fall. Expect groups like the Florida Society of Rheumatology, the Florida Academy of Pain Medicine, pharmaceutical companies and insurers start to form coalitions, hire lobbyists and PR firms, and start messaging campaigns aimed at gaining the favor of a conservative legislature eager to find ways to deliver lower costs through free market reforms.