PBMs, or Pharmacy Benefit Managers, are supposed to be a cost-saving measure for health care consumers. However, the way they are structured and operate often has the opposite effect. PBMs are essentially middlemen between health insurance companies and pharmacies, and they are responsible for setting prices and determining the drugs that will be covered by health plans. Unfortunately,

PBMs have become increasingly powerful and are not always operating in the best interest of consumers. One example of how PBMs are a bad value for healthcare consumers is the way they use drug price tiers. PBMs typically set up tiered formularies, which are lists of drugs that are grouped based on price and effectiveness. Drugs in the highest tier, which are typically the most expensive, will be required to be used before drugs in the lower tiers can be prescribed. This leaves consumers with few options and often results in them having to pay more for the drugs they need. Additionally, PBMs often receive kickbacks from drug companies, which can further drive up costs.

Another way in which PBMs are a bad value for healthcare consumers is their use of step therapy. Step therapy is a process in which a doctor must first prescribe the least expensive drug, and if that is not successful, then the doctor must prescribe more expensive drugs until the patient is successful. This often leads to patients being prescribed more expensive drugs than necessary and having to go through multiple drug trials before finding one that works. Finally, PBMs often use restrictive formularies that limit the drugs that are covered by a health plan.

This means that certain drugs may not be covered, meaning consumers must pay out-of-pocket or seek alternative treatments. In conclusion, PBMs can often be a bad value for health care consumers. They can drive up the cost of drugs by setting up tiered formularies, utilizing step therapy, and restricting formularies. For these reasons, it is important to be aware of how PBMs operate and take steps to ensure that health care consumers are not being taken advantage of.

There is A Better Way