The drug supply chain can be a complicated process. There are many different layers that go with the process that ultimately ends with your prescriptions making their way into your medicine cabinet, especially when it comes to deciding the amount each entity within the process pays. While the structure of this supply chain remains seemingly intricate, there is one thing relatively easy to understand: Middlemen at the center of this process often do not share the savings they negotiate with consumers at the pharmacy counter.
These “middlemen” who negotiate medicine prices for insurance plans are officially known as pharmacy benefit managers (PBMs), and they negotiate steep discounts for the medicines they cover. Yet, when it comes to passing on the savings they negotiate with patients, they have failed time and time again -- leaving seniors with the raw end of the deal.
In Medicare Part D, for the past 10 years, seniors have had affordable coverage to access the prescription drugs they rely on. However, in recent years, seniors have begun to face increasing out-of-pocket costs that have made that access more difficult. A simple answer to these affordability challenges is for PBMs to share some of the savings they negotiate with seniors at the pharmacy counter. Sharing these savings has multiple benefits.
It would reduce out-of-pocket costs directly for seniors when they pick up their prescriptions, and in turn, they would be more likely to stay on their medicines. When patients are more adherent to the medicines they need to manage their conditions, they have fewer doctor visits and most importantly, fewer or shorter hospital stays. The increased adherence because of sharing the savings would therefore lead to savings across the entire Medicare program, as seniors wouldn’t require as many medical visits.
One would think something like this would be simple, that it would not take much to enact a fair system in which middlemen are fair to consumers passing on the savings they negotiate on their behalf. With more than one-third of the initial list price being rebated to the PBM and not the consumer, patients are missing out on these beneficial, negotiated savings that could help tremendously in driving down costs for prescription medicines.
A recent poll indicates that 89 percent of seniors agree that Part D could work better by improving affordability and predictability of prescription drugs at the pharmacy counter -- and to make this goal a reality, mitigating out-of-pocket costs is a step in the right direction. In fact, by a 2-to-1 margin, seniors said they would rather lower out-of-pocket costs over lower premiums in Medicare Part D.
In my role as vice president of the PPSC, my professional life is devoted to ensuring the highest quality pharmacy services to meet and exceed the unique needs of our customers. Prescription medicines are vital to seniors’ health and it is important that they have access to the quality care they deserve. Seniors share the costs, so why shouldn’t they be entitled to the savings? It’s time to tell lawmakers to protect seniors the way Medicare was originally intended -- and that starts with passing these rebates on to patients so they may continue to live healthy, long lives.
Bill Mincy is vice president of Tallahassee-based PPSC, one of the nation's oldest and largest pharmacy service firms.