Pharmacy benefit management (PBM)

Medicaid programs willing to boot out drug pricing middlemen

A pharmacists talks to a customer, who is standing in front of a counter.
Pharmacy benefits are changing in many state Medicaid programs. Photo: Scott Olson/Getty Images

Michigan's Medicaid program is proposing to fire the pharmacy benefit managers that handle its prescription drug claims and negotiate prices. The state would manage drug coverage itself, starting Dec. 1.

The big picture: More state Medicaid agencies have determined that outsourcing all negotiations and operations of prescription drugs to PBMs has not produced the dramatic savings they were promised.

Pharmacy benefit managers pass along a lot of Medicare rebates

Prescription medicine staked on top of each other
Photo: Paul Linse/Getty Images

Pharmacy benefit managers negotiated $18 billion worth of rebates from drug manufacturers within Medicare’s prescription drug program in 2016, and they retained less than 1% of those rebates for themselves, according to a new Government Accountability Office report.

The big picture: This isn’t surprising, as Medicare is structured so that PBMs pass pretty much all rebates back to the federal government. While the GAO report offers a good base of how middlemen affect drug prices in Medicare, it does not fully address larger issues.