PBMs or Pharmacy Benefit Managers are “middle men” in our convoluted for-profit healthcare system. They act as third-party administrators of prescription drug programs for health plans, employers, and other organizations. They aim to control costs and improve the efficiency of prescription drug benefits. However, as consumers we have little access or transparency in this industry. Knowledge about the profits of PBM’s is difficult to ascertain, as they may be intertwined with health plans and insurance companies. Among their many responsibilities, PBMs can influence which drugs are covered by insurance companies and whether certain prescriptions can only be filled at specialty pharmacies. This can lead to “sweetheart deals” and a lack of transparency for patients and health plans.

https://www.kff.org/health-costs/poll-finding/public-opinion-on-prescription-drugs-and-their-prices/ 

As we seek to establish a simplified health system in Oregon, understanding where ALL the money is in the healthcare industry is tantamount to achieving our goal.

According to the Kaiser Family Foundation, “the public sees profits made by pharmaceutical companies as the largest factor contributing to the price of prescription drugs. At least eight in ten across party lines say profits made by pharmaceutical companies are a “major factor” in the price of prescription drugs. This is followed by more than half who say the cost of research and development is a “major factor” contributing to the price, and about half saying that the cost of marketing and advertising is a major contributing factor to the cost of prescription drugs.”

With the 2024 State Legislative Session fast approaching, HCAO will monitor legislative action on PBM’s and work to make certain that the Universal Health Plan Governance Board understands the role that PBM’s play and how to increase transparency and reduce costs in the pharmaceutical industry. Are you interested in the Legislative process or reducing the cost of prescription drugs? We need you to engage with lawmakers to prioritize health issues in 2024. Reach out to volunteer@hcao.org  if you want to volunteer!!