Pharma Not the Only Ones Upset with PBM Practices

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The National Alliance of Healthcare Purchaser Coalitions is pointing the finger at pharmacy benefit management or PBMs for high prescription drug costs. In a recent press release, the National Alliance encouraged employers to challenge the industry misalignment of PBMs behind-the-scenes role. Michael Thompson, National Alliance president and CEO, said, "With health plans and PBMs increasingly owning each other and the growing side deal payment arrangements to consultants and brokers, this is a classic case of the 'fox guarding the henhouse'."

To address this, the National Alliance has created a playbook, its resource that examines the role of the fiduciary in pharmacy benefit management and offers insights on the drivers of pharmacy benefit costs and value, and flaws in the contracting and negotiation process. It offers employers or health purchasers access to best practice checklists, sample questionnaires for selecting consultants and recommended contracting language.

The National Alliance maintains some of the concerns surrounding PBM practices include promotion of higher-price drugs when lower-price drugs are available; systematic approaches to encourage waste including refilling too soon or automatic 90-day refill; a narrow definition of "rebates" which allows the PBM to "pocket" 50% or more of the manufacturer revenue because they have been recharacterized as something else, and plan sponsors being "held hostage" on any and all PBM contract terms, financial guarantees, and provisions regardless of magnitude of desired benefit changes.

Reference: Purchaser Coalitions Releases Call to Action for Employers to Address Conflicts in the PBM Industry, Washington, June 26, 2023, PRNewswire.