Another reason is the adverse impact PBMs have on drug costs. PBMs earn revenues, in part, by charging various fees to pharmacies. Some of these fees effectively require pharmacies to pay PBMs for the right to be compensated by the PBMs. If that sounds complicated, it’s because it is.
PBMs also earn revenues based on the difference between the manufacturer rebates and discounts and the list prices of medicines. This compensation system creates potential conflicts between a PBM’s financial interests (to push the medicines with the biggest discounts and rebates) and each beneficiary receiving the best medication clinically. Since there is no PBM transparency however, there is no ability to evaluate these potential conflicts.