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What are pharmacy benefit managers and what role do they play in the price of your prescriptions?

James Yarema

If you have health insurance and it comes with a prescription drug plan, it may be managed by a pharmacy benefit manager. PBMs are companies that manage prescription drug benefits on behalf of health insurers. By negotiating with drug manufacturers and pharmacies to control drug spending, PBMs have a significant impact in determining total drug costs - and they have faced growing scrutiny about their role in rising prescription costs and spending.

Ohio Attorney General Dave Yost began investigating PBMs in 2018 while he was state auditor. Then this summer the PBM Centene Corp. agreed to pay the state of Ohio $88.3 million to settle a lawsuit filed by Yost alleging the pharmacy benefit manager overbilled the Ohio Department of Medicaid for pharmacy services it provided.

Joining Cincinnati Edition to discuss pharmacy benefit managers and what is being done at the state and federal level to reign in PBMs are National Consumers League Executive Director Sally Greenberg; and 3 Axis Advisors President and 46 Brooklyn Research CEO Antonio Ciaccia.

Greg Lopes, a spokesperson for the Pharmaceutical Care Management Association released a statement to us regarding pharmacy benefit managers.

“Any assertion that pharmacy benefit managers, PBMs are raising drug costs is completely false. The primary mission of PBMs is to reduce prescription costs for patients. PBMs advocate on behalf of Ohio’s consumers and health plan sponsors by negotiating with drug manufacturers and drugstores to keep prescription drugs accessible and affordable. In fact, PBMs are the only member of the prescription drug supply chain focused on reducing drug costs.

While drugmakers alone have the power to set and raise prices, PBMs reduce prescription drug costs, while also fairly compensating pharmacies for services they provide.”

Listen to Cincinnati Edition live at noon M-F. Audio for this segment will be uploaded after 4 p.m. ET.

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