Lifting the veil on PBM prices -Bukaty-Hubsopt-Summer-2022

    Lifting the veil on PBM prices

    Authored by Bukaty Companies on July 6, 2022

    The proposed Pharmacy Benefit Manager Transparency Act of 2022 is among the latest efforts to contain rising costs and increase transparency of health care spend and stop unfair pharmacy benefit manager (PBM) practices.

    This bipartisan legislation seeks to make it illegal for PBMs to utilize spread pricing. PBMs negotiate prescription drug prices with pharmacies on behalf of health insurance companies, self-insured employers and government programs.

    Spread pricing occurs when a PBM charges a health plan a higher price than the amount reimbursed to the pharmacy and pockets the difference. In some instances, health
    insurance plan premiums increase to cover the middleman costs, passing the financial burden on to consumers.

    The proposed bill would require PMBs to

    • pass along 100% of any drug manufacturer rebate to the health plan or payer, and
    • disclose to the Federal Trade Commission each year comprehensive price, reimbursement, fee, markups and discounts PBMs charge or impose on health plans and pharmacies.

    If passed, this legislation could be a momentous step toward lower prescription drug costs. The National Community Pharmacists Association is in support of the Act.

    Bukaty Companies will continue to monitor the situation and release updates as necessary.



    Blog Category: Benefits