Pharmacy Benefit Managers (PBMs) were designed to negotiate drug prices between pharmaceutical companies and insurers on behalf of patients. But instead, they’ve built a completely secret system that maximizes their own profits. By integrating with insurance companies as well as with large retail chain pharmacies, PBMs have gained massive control over which medications are available and at what price, driving up costs for patients and taxpayers while they pocket the savings. PBMs work behind the scenes, negotiating opaque “rebate” deals with pharmaceutical companies that determine which drugs are covered by insurance and often blocking access to lower-cost generic and biosimilar alternatives. However, these deals are hidden from public view, making it impossible for patients to know whether they’re getting the benefit of savings—or if PBMs are keeping the profits for themselves.
The U.S., which pays the highest drug prices in the world, is the only country where PBMs exist. The top three PBMs control more than 80% of the prescription drug market and are vertically integrated with both pharmacies and insurers, allowing them to manipulate the system to their advantage. One common practice is negotiating secret rebate deals with drug manufacturers, incentivizing PBMs to prioritize expensive medications over lower-cost alternatives. They also frequently exclude generics and biosimilars from formularies in favor of higher-priced drugs that yield larger rebates.
PBMs were supposed to save patients money, but they’ve become another link in the chain driving up drug prices.”
Bob ParantLong Island, NY
We are committed to exposing the role of PBMs in driving up drug prices and advocating for reforms that put patients first. As PBMs face increasing scrutiny for anti-competitive practices, including a recent lawsuit filed by the Federal Trade Commission (FTC) against the largest PBMs, it’s clear that reform is urgently needed. Patients and lawmakers across the political spectrum agree: more transparency is essential to ensure that savings are passed on to patients, rather than pocketed by PBMs. Through direct patient advocacy, we are working to dismantle the harmful practices that block access to affordable medications. Our goal is to ensure that patients—not middlemen—benefit from the savings generated in the drug supply chain, making life-saving medications more affordable for all.