“We applaud the Senate Finance Committee for holding today’s hearing and look forward to setting the record straight on the role of pharmacy benefit managers (PBMs) in the prescription drug supply chain.
PBMs are the primary advocates for consumers and health plans in the fight to keep prescription drugs accessible and affordable, and serve as the only check in the prescription drug supply chain against drugmakers’ sole power to set and raise prices.
PBMs have been able to achieve an overall stable cost trend for prescription drugs by negotiating with drugmakers and drugstores, and incentivizing use of the most cost-effective, clinically appropriate medications. The PBM-negotiated savings on prescription drugs result in reduced premiums and costs at the pharmacy counter. For example, in Medicare Part D, PBMs have been integral to keeping the average premium steady and affordable since the program began, and to limiting overall program costs for taxpayers below original projections.
As policymakers consider these issues, there is a constructive conversation to be had on how best to balance the use of PBM-negotiated prescription drug savings between premium reduction and lower out-of-pocket costs.
Currently, when it comes to utilizing PBM-negotiated price concessions, the most common agreement among PBM clients is a 100 percent rebate pass-through model.
We are concerned that the Administration’s proposed rule revising the safe harbors around prescription drug rebate negotiations in Medicare and Medicaid managed care will cause disruption to the Part D benefit and the drug supply chain should PBMs’ ability to effectively negotiate and facilitate price concessions be diminished. If the proposed rule moves forward, PBMs have the infrastructure, tools, and data to best operationalize a restructured system.
We stand ready to work with policymakers and the Administration to reduce list prices and costs to consumers.”