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Another Voice: Benefit managers contribute to high drug prices

By Ted Okon
For a professor of pharmaceutical ethics, John Jones’ recent Another Voice column, “Blame drugmakers for high-priced drugs,” is a disappointing example of the kind of ethical blindness that has left our health care system with the problem of insanely high drug costs.

There is no doubt that drugmakers share the blame for high drug prices. But they are just one part of a larger drug system that is broken. If our country truly wants to lower drug prices, then it should take a long hard look at the role played by pharmacy benefit managers (PBMs).

It is no longer a secret that PBMs are a dominant player in the U.S. health care system. Today, just three PBMs control prescription drug benefits for 80 percent of Americans. They make billions of dollars in profits as middlemen in our health care system while delivering no actual patient care. In fact, what they do to the patients forced to use them often feels like just the opposite.
Every day my inbox is flooded with pleas for help from cancer clinics across the country struggling to help patients stuck in the bureaucratic purgatory of PBMs.

Medication delays that often last over a month, denials of lifesaving treatments and endless hours spent on the phone with unaccountable PBM representatives are the norm, not the exception.
Stuck in the middle of all this are very real and sick Americans who just want to get better.

PBMs argue that the rebates they get from pharmaceutical companies help control drug prices. What they refuse to disclose is how much (or how little) of those savings are passed on to patients. In fact, it might surprise some to know that PBMs have been waging a tone-deaf battle to avoid disclosing where those rebates go and who benefits – all while pointing the finger at everyone else in the system.

Additionally, PBMs fail to acknowledge the economic fact that discounts always get priced into prices. So, as they extract higher and higher discounts from drugmakers they are just driving drug prices higher.

Worse yet, because PBMs make percentage-based fees from pharmacies, they have a perverse incentive to keep drug prices high.
PBMs are not innocent bystanders – they are a direct cause of high drug prices. Yet, when it comes time to finding solutions, all PBMs do is point fingers.
It is time to drop the charade and address this head on. We need more transparency and accountability from PBMs and we need it now.

Ted Okon is executive director of the Community Oncology Alliance, a non-profit dedicated solely to preserving and protecting access to community cancer care, where the majority of Americans with cancer are treated.

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