Prescription costs are rising, and there’s more to it than just drug companies. Pharmacy Benefit Managers (PBMs) are hidden middlemen who often drive up prices and limit access to affordable medications. Here’s what you need to know about how they could be affecting your healthcare:

 

Key Takeaways You’ll Learn: 

• Pharmacy Benefit Managers (PBMs) often drive up prescription costs instead of reducing them, impacting patients and small pharmacies.
• PBMs frequently push patients toward more expensive brand-name drugs, even when cheaper generics are available.
• Local, independent pharmacies are being squeezed out by unfair PBM practices, limiting healthcare access in many communities.

What Are PBMs?

PBMs are companies that manage prescription drug benefits on behalf of health insurers, employers, and government programs. They control what medications your insurance covers and negotiate prices with drug manufacturers.

Sounds helpful, right?

In theory, they should save everyone money by securing lower prices. But it turns out, PBMs have found ways to increase their profits at the expense of both patients and the small pharmacies who want to help them.

The Problem: Higher Prices and Fewer Choices

One major issue is that PBMs often push patients toward more expensive brand-name drugs instead of cheaper generics. Why? Because they get bigger rebates and hidden fees from drug companies when they do.

Unfortunately, these higher costs are passed on to patients, especially those with high-deductible plans or those who pay a percentage of the drug’s list price.

Even more troubling, some patients struggle to get their medications at all. Independent pharmacies, especially in rural or underserved areas, are being squeezed out because PBMs often reimburse them at rates that don’t even cover the cost of the drugs. When these local pharmacies close, communities lose valuable access to care.

A Broken System

Many people don’t even realize PBMs exist until they face issues getting their prescriptions filled. Whether it’s higher out-of-pocket costs, delays in receiving medication, or being forced to use a mail-order service instead of their preferred pharmacy, patients are left navigating a confusing and frustrating system.

What’s worse is that these PBMs are becoming more dominant, controlling about 80% of the prescriptions in the U.S. This level of control allows them to prioritize profits over patient care. While they claim to save money, the reality is that their practices often drive up overall healthcare costs.

Losing Your Freedom of Pharmacy Choice

Another hidden impact of PBMs is how they limit where you can fill your prescriptions. PBMs often steer patients to mail-order services or specific pharmacies that they own or are affiliated with. This practice forces you away from local, independent pharmacies, reducing your options and making it harder to get personalized care. It’s all part of a broken system that prioritizes profits over your health and convenience.

What Can Be Done?

There’s growing scrutiny of PBMs from both lawmakers and patients. Some states and companies are pushing back by choosing different benefit managers or exploring ways to increase transparency in drug pricing. But for now, it’s important to be aware of how PBMs might be affecting your prescription costs and access to care.

At Friendly Pharmacy, we believe in putting our community first. That’s why we work hard to advocate for our patients and provide personalized care without the barriers created by big PBMs. We’re here to help you navigate these challenges and ensure you get the medications you need, hassle-free.

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