There are a few more papers on pharmacy benefit managers (PBMs) that I want to read at some point so I can complete this area of study (for now). But today I want to share a few quotes about PBMs that anonymous pharmacists wrote when I was having some of my pharmacist friends ask their other pharmacist friends:
“Just let him know every pharmacy has an AWFUL relationship with PBMs.”
Multiple pharmacists used the same word, “theft,” when describing PBMs.
“All I can say is I don’t know directly how PBMs make their money other than charging companies high prices and negotiating pharmacies to make very little in comparison.”
“I don’t remember the exact details as far as $$ amounts but this example is true. We had a Tricare patient come into our pharmacy upset after looking over his health statement from his insurance company and seeing if we really charged his insurance $200 for a product. We looked over everything on our end and learned the product cost was $20 and our profit was $7, so the total collected was $27. This means that the PBM chose to charge the government $200 and kept $173. Again the $$ may be a little skewed but I recall the dollar amount the PBM paid itself was significant. Adding more middle men doesn’t decrease costs it increases them.”
“Seriously, and they are not transparent! They don’t give the pharmacy access to those numbers, they don’t give us access to the contracted costs. When contracted costs change, we aren’t notified. Then there’s DIR fees to add into the mix. They try to put gag orders on pharmacies, threatening to throw them out of network if they communicate about any of it. They just want us to sit down, shut up, and take whatever they give us. And they don’t even tell us what they’re giving to us! There’s no negotiating.”
Clearly there are some pretty adversarial relationships between pharmacies and PBMs! But remember that this doesn’t reflect all pharmacists’ opinions on the topic, so don’t use it to adjust your prior too much, but my sampling of friends (and friends’ friends) had pretty uniform negative responses about PBMs. This may be a reflection of pharmacists who run independent pharmacies feeling powerless against PBMs because they have almost no bargaining power when they are up against these juggernaut PBMs. This is how bargaining power works–the bigger guy on one side of the table can command the lion’s share of the profit when negotiating with the little guy sitting across from him.
Clear Thinking on Healthcare 