A national coalition of pharmacists and pharmacy owners announced last week a public information campaign to expose the unjustifiably high prices of prescription drugs set by pharmacy benefit managers, the unregulated, multibillion dollar industry that controls prescription health plans for more than 200 million Americans.
Pharmacists United for Truth and Transparency, a growing 600 member coalition spread across 40 states, was formed to protect benefit plan sponsors and enrollees from overpaying for prescription drugs. The need for greater awareness of PBMs’ roles in the American health care system grew stronger in July when Express Scripts Inc. and Medco Health Solutions announced merger plans that would create the largest PBM in the nation.
"Pharmacists are in a unique position to compare actual prescription drug prices with the amount PBMs charge for the same lifesaving medications," says Dave Marley, a founding member of Pharmacists United for Truth and Transparency. "Americans will demand swift and serious reforms when they see examples of their outrageous markups."
A recent press release from the Pharmaceutical Care Management Association, a trade group funded by PBMs, states their industry "will save consumers and payers almost $2 trillion in prescription drug costs" over the next decade. Pharmacists United for Truth and Transparency was created to debunk these statements by publicizing actual PBM price sheets and claims data. An example obtained by Pharmacists United for Truth and Transparency last month shows the lack of transparency in one PBM contract led the plan sponsor to overpay for prescription benefits by nearly $2 million over a three year period.
Increased skepticism of PBMs is playing out across the nation in state and federal governments. Legislators in New York this summer passed a bill that bans mandatory mail order programs for prescription drugs. Similar legislation is being drafted in Pennsylvania. Nationally, a bipartisan group of 14 members of Congress stated in a letter to the FTC last week that an unregulated merger of Express Scripts and Medco would give the corporation "the ability to raise prices and/or block pass through pricing for plans and patients – ultimately limiting critical access." They called for a "full and thorough investigation" of the proposed deal, "including examining the impact the merger will have on consumers, patients, third party and federal payers."
"The fact that the profits of the major PBMs have increased by over 400% in the last five years is proof that our health care system isn't working," says David Balto, an antitrust attorney and former Policy Director at the Federal Trade Commission (FTC).
