Get the Facts
How PBMs Reduce Drug Costs in High-Deductible Plans

Fact: As medical costs rise, more employers, unions, and government programs are offering lower cost, high-deductible plans. Pharmacy benefit managers (PBMs) help stretch health care dollars further by reducing pharmacy costs by 30%.

  • Most plans take those manufacturer rebates and other savings and use them to reduce premiums for all their enrollees.  Others use them to reduce out-of-pocket costs for specific patients who may need certain high-priced drugs.
  • Whatever the plan decides, PBM savings help them reduce the costs of drugs and overall health benefits.
  • Most consumers blame drug companies, not insurers, for higher cost-sharing.
  • As a percentage of overall out-of-pocket consumer spending, cost-sharing has actually gone down for prescription drugs to below 20%.

Survey: Consumers Hold Drug Companies Responsible for High Drug Prices and Out-of-Pocket Costs

Survey results show that by an almost 3-to-1 margin, voters blame high drug prices for increased cost-sharing, and only 1-in-5 voters buy the drugmakers’ “rebates cause high prices” message.

 

Kaiser Family Foundation Research: Annual Out-of-Pocket Spending Decreasing for People with Employer Coverage  

On average, annual out-of-pocket spending on prescriptions by people with large employer coverage dropped by about $24 from 2009 – 2014.

Solving the Mystery of Employer-PBM Rebate Pass-Through

Pharmacy benefit managers (PBMs) pass back to employers more than 90% of total rebate dollars, received from brand-name pharmaceutical manufacturers, according to Drug Channels.