Lobbyists with the pharmacy benefit management industry met with federal officials last month, warning that Medicare Part D premiums will rise by 22% in 2019 if the government pursues an idea that would lower what Medicare patients pay for medications at the pharmacy counter.
Why it matters: PBMs and other companies that sell Medicare drug plans dislike the proposal, which would require them to apply rebates and fees at the point of sale as a way to make drugs cheaper, and a final ruling is expected soon.
A contract template used by Express Scripts, the largest pharmacy benefit manager in the U.S., provides a window into how pharmacy benefit managers — middlemen that manage drug coverage for businesses throughout the country — steer negotiations with drug companies to benefit their own financial interests.
Why it matters: These benefit managers have a lot of power over the prescription drug coverage people get through their employers, and they're supposed to negotiate discounts so coverage is cheaper for insurers and employers. If they're not making it cheaper, there's less chance people will get relief from high drug prices.
