St. Louis Reporter

Connie Farrow, Executive Director of advocacy group Patients Come First – Missouri, said she concurs with recent comments made to the St. Louis Reporter by Dr. Rita Numerof about the role pharmacy benefit managers (PBM) play in driving up prescription medication costs for patients.  

“Consumers should be alarmed by the recently-released Federal Trade Commission interim report accusing the nation’s largest pharmacy benefit managers of wielding enormous power over patients’ ability to access and afford their medicines. Drug manufacturers provide deep discounts and rebates, but far too often these savings don’t get shared with the patients for whom they are intended,” Farrow told St. Louis Reporter. 

“In addition, PBMs have consolidated the delivery of medicines by merging with or acquiring other entities within the supply chain, allowing them to serve as health plans and pharmacists, among other roles. This is due to a lack of transparency and accountability mechanisms within the pharmacy supply chain that have allowed bad actors to pocket these drug rebates.”

A PBM is a third-party administrator of prescription drug programs for health insurers, self-insured employers and government agencies. PBMs negotiate with drug manufacturers to secure discounts and rebates on medications, manage pharmacy networks, and process prescription drug claims. PBMs also provide services such as medication therapy management and mail-order pharmacy services.

The Federal Trade Commission (FTC) has released an interim staff report on the prescription drug middleman industry. According to an FTC press release, the interim report, required by a special order issued by the FTC in 2022, outlines how increased vertical integration and concentration have contributed to the rise of six PBMs that now manage almost 95% of the nation’s prescriptions.

The FTC asserts that this vertical integration and concentration have led to PBMs profiting at the expense of patients and independent pharmacists. “The FTC’s interim report lays out how dominant pharmacy benefit managers can hike the cost of drugs—including overcharging patients for cancer drugs,” FTC Chair Lina M. Khan stated in the press release. “The report also details how PBMs can squeeze independent pharmacies that many Americans—especially those in rural communities—depend on for essential care.”

Farrow explained if the PBMs’ rebate system “functioned as it should, and as consumers are led to expect, patients would notice a reduced price for their medicine when paying at the pharmacy.”

“These discounts could mean the difference between patients getting a pricier advanced prescription that improves their health or not being able to afford a medication, skipping doses, or opting out of the care plan altogether. Given all of the advanced treatments and medications our healthcare system has to offer, it’s unacceptable that patients may have to skip a prescription because a discount wasn’t passed along to them,” Farrow said.

“Patients should feel encouraged that the FTC plans to investigate further how PBMs are manipulating the system and act accordingly to ensure patients and consumers are able to affordably access the medicines they need where they live.”

Patients Come First – Missouri is a consumer movement aimed at putting patients and consumers back at the forefront of healthcare through advocacy, science, education and collaboration.