PCMA on Drug Pricing, Transparency, and the Role of PBMs

Prescription drug prices in the US have soared dramatically in the past few decades. While fingers are being pointed at various entities that make the pharmaceutical supply chain run smoothly, industry experts have spent years to find out who is responsible for unaffordable access to medications.

One of the lesser-known groups that deals with multiple facets of the supply chain—often referred to as pharmaceutical middlemen—pharmacy benefit managers (PBMs) serve as an intermediary between pharmacies, insurance companies and employers, and drug manufacturers and wholesalers.¹ Due to vertical integration, formulary design, and other patient-steering tactics, major PBMs—and the affiliated pharmacies and insurers that work with them—have been able to take over a significant portion of the pharmacy benefits market.

Johnny Garcia, Senior Director of Policy at the Pharmaceutical Care Management Association | image credit: Johnny Garcia

At the same time as PBMs flourishing financially and taking control of the market, pharmacies are shutting their doors thanks to declining reimbursements from manufacturers amidst high-demand drugs skyrocketing in price. While those in the pharmacy profession are blaming PBMs for ongoing financial struggles, the Pharmaceutical Care Management Association (PCMA) claims that the PBMs are not the issue.

In the most recent episode of Over the Counter, Johnny Garcia, Senior Director of Policy at the PCMA, sat down with Drug Topics to discuss the common misconceptions surrounding his organization and PBMs as a whole, as well as the work they do to support 17 of the 73 PBMs in the market today. While PBMs and the PCMA are currently on the hot seat when it comes to reform within the prescription drug market, Garcia tried to shed some light on what exactly he thinks is the root cause of rising drug costs.

This interview is part of a larger ongoing series covering PBMs and how they impact independent pharmacies. From the perspective of legal experts, independent pharmacy owners, and leaders of advocacy groups, be sure to catch up on our coverage of the industry’s pharmaceutical middlemen and the animosity that surrounds them:

• How PBMs Impact Independent Pharmacies
• Litigation Lawyer on PBMs and Defending Independent Pharmacies
• NCPA Representative Discusses Role in Influencing PBM Reform

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Reference

1. Mattingly TJ, Hyman DA, Bai G. Pharmacy benefit managers: History, business practices, economics, and policy. JAMA Health Forum. 2023;4(11):e233804. doi:10.1001/jamahealthforum.2023.3804