Patients Should Not Have to Wait Until 2028 for Accountability

REALCLEAR HEALTH

Prescription drug prices keep rising, driven in part by a system in which pharmacy benefit managers (PBMs) sit at the center—controlling which drugs are covered, what pharmacies are paid, and what patients ultimately spend. Yet their profits are tied to higher prices, not lower ones, creating a system where the middleman benefits when costs rise. As long as those incentives remain hidden, patients are left paying the bill with no way to challenge it. Bringing transparency to PBM pricing and compensation is the first step to exposing these misaligned incentives and forcing the market to work in favor of patients rather than PBMs. Congress has taken steps in that direction, but the reforms will not go into effect until 2028, leaving state legislatures as patients’ hope for transparency in the meantime.

PBMs profit from high-priced drugs that offer rebates. Instead of passing those rebates on to patients, PBMs retain some or all of them, leaving patients paying more than they would for a generic alternative. In turn, brand-name manufacturers are incentivized to raise both prices and rebates, increasing what PBMs can capture at the patient’s expense.

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