Get the Facts
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%.
Pharmacy Benefit Managers
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PBMs support benefit designs that ensure patients do not pay more in cost-sharing than the cost of an actual drug.
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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.
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Whatever the plan decides, PBM savings help them reduce the costs of drugs and overall health benefits.
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Most consumers blame drug companies, not insurers, for higher cost-sharing.
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As a percentage of overall out-of-pocket consumer spending, cost-sharing has actually gone down for prescription drugs to below 20%.
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.
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.