NCPA's Blog - The Dose

The Dose

The "Smoke and Mirrors" of PBMs

by Jayne Cannon | Feb 20, 2018

We talk a lot about PBM abuses, but there's no better way to illustrate the real-life impact of PBMs than hearing examples of what goes on in community pharmacies across the nation every day. In the coming weeks, we'll feature some of these stories from NCPA members who've told us how PBMs mislead and mistreat patients and pharmacies. If you have a true-life tale to tell, send us a note today.

One community pharmacist told us that the PBM industry is using what he calls "smoke and mirrors" to pad their profits and drive small pharmacies out of business. He thinks there is a serious lack of transparency as to how they calculate copays and reimbursements and how they reimburse the pharmacies.

The pharmacist cites a recent example. He has a patient who had just been discharged from a mental health facility and was prescribed an anti-psychotic medication. The patient's copay was $462.99, the PBM clawback profit was $453.59, and his pharmacy made a net profit of $3.57. Yes, that's three dollars and 57 cents. He says it is just plain wrong to treat patients, and pharmacies that are providing a valuable service to patients, this way. This pharmacist encourages more of his colleagues to provide more examples, saying that if enough of them speak out, things might start to change.