Topic: Pbms

Donald Trump issued an executive order aimed at lowering prescription drug prices to match the "most favored nations" rates paid in Europe. Robert F. Kennedy Jr. praised the move, noting that while Democrats like Bernie Sanders have promised this for decades, the pharmaceutical lobby's influence in Congress prevented action. The plan involves cutting out "middlemen" known as Pharmacy Benefit Managers (PBMs).

Executives from the three largest Pharmacy Benefit Managers (PBMs)—CVS Caremark, Cigna Express Scripts, and UnitedHealth Optum—faced a bipartisan grilling in Congress. They are accused of inflating drug costs and squeezing independent pharmacies. Representative Ro Khanna cited a case of a child denied arthritis medication for six months due to PBM bureaucracy, while executives claimed they saved clients $64 billion.

An interim FTC report alleges that PBMs aggressively steer patients toward high-cost specialty drugs and preferred pharmacies to maximize profits. For example, a generic leukemia drug costing $66 was reimbursed at $2,700. Former FDA Commissioner Scott Gottlieb explains how the "back-ended rebate" system allows PBMs and insurers to profit while patients pay high out-of-pocket costs at the pharmacy counter.

The high cost of Ozempic in the U.S. is attributed to Pharmacy Benefit Managers (PBMs) who manipulate drug coverage and pricing. While the drug is patented until 2026, some patients are using compounded versions mixed with Vitamin B12 to save money, though the U.S. price remains significantly higher than in other countries.

The role of Pharmacy Benefit Managers (PBMs) is identified as a primary driver of high drug costs through "spread pricing" and rebate scams. These middlemen allegedly inflate the price of generic drugs and pocket the difference, which President Trump's new executive orders seek to eliminate by mandating that rebates go directly to consumers.