Health Care Debate: Regulate Prescription Benefit Managers

July 08, 2009

(As submitted to The Hill)

To the Editor:

One roadblock to real health care savings ("Dems to show how they will find $1 trillion" July 6, 2009) is America's broken prescription drug payment system. The current lack of transparency and accountability allows pharmacy benefit managers (PBMs)—the determiners of which medicines are covered by health plans and how much patients pay for them—to put their profits above everyone else's interests, including their clients'.

For example, patients today are often incentivized to get generic prescriptions filled through a PBM's mail-order program even though a community pharmacy can do it less expensively, while also more effectively managing medication therapy. These transactions end costing patients, employers and other plan sponsors far more in insurance costs due to hidden PBM fees.

The remedy is for Congress to set up a way to regulate PBMs. Such reforms would save patients and the private sector billions and lower the cost of government health care plans like Medicare and Medicaid.

Bruce T. Roberts
Executive Vice President and CEO
National Community Pharmacists Association
Alexandria, VA

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