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Debate over pharmacy benefit managers a matter of price vs. cost

The mantra we hear over and over by pharmacy benefit managers (PBMs) is that they “reduce the cost” of medicines. What they don’t tell us is that they reduce the cost of medicines for themselves – not for the patients. This was a point of contention that came up recently when I testified before the U.S. House Energy & Commerce, Health subcommittee.

There is a big difference between price and cost when it comes to medications. There may be one list price for a medicine but many different costs depending on who is buying the medicine. Blame falls squarely on the manufacturers for setting high list prices and increasing them year after year. That list price is what it costs patients to buy the drug who have no insurance coverage. That list price is also what is used by PBMs to calculate a patient’s coinsurance for specialty drugs. Patients bear the burden of that high list price.

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Barbara Arnago