By Sherri Blevins
Prescription drug costs for individuals are projected to increase in 2019 according to an article by the Kaiser Family Foundation. In a recent poll conducted by the Foundation, one in four people polled are having difficulty affording their medication. According to Sylvania pharmacist, Rodney Williams, the majority of the medications seeing an increase are generic drugs. Patients’ co-pays are all over the place due to the cost of medications. The organization that is driving up the cost is the Pharmacy Benefits Managers (PBM).
According to the American Pharmacists Association, “PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims.”
Simply stated, a PBM is a company that administers, or handles, the prescription drug benefit component of your employer’s health plan. A PBM processes and pays for your prescription drug claims and is responsible for assisting your employer with managing the prescription benefit.
The Kaiser Family Foundation also reported that 52% of respondents they polled said that passing legislation to bring down the price of prescription drugs should be the government’s top priority.
Williams explained that the PBM’s are costing the general public lots of money every year. For example, if a drug cost $10.00, the PBM can charge the insurance $30.00 for medication, give the pharmacy the cost of the medication and keep the remaining.
He went on to say, “There is no control over the PBMs, and they are allowed to do as they please. Four major PBMs control the majority of the prescription business in the country leaving the consumer with very few options. It will take local and federal oversite to ever correct this problem. Always ask your pharmacist if there are cheaper alternatives to your medication.”