Jim Maxwell: To Address Rising Drug Costs, Mischaracterization of PBMs Deserves Scrutiny

If Florida’s lawmakers are to address the rising costs of prescription medications, it is our hope that they do so with all the facts.

There has been much discussion and debate recently about pharmacy benefit managers (PBMs), specifically suggesting that they’re responsible for the increased drug prices that Florida’s seniors are facing. These are serious claims that deserve some very close scrutiny.

First, it is pharmaceutical companies that set the prices for prescription drugs. Cases where manufacturers have increased prices on critically needed medications by such large percentages are not unusual; we’ve seen a number of such stories over the past few years.

So why is there such an orchestrated campaign to blame others for such a problem? We should all be suspicious.

What many people don’t know is that PBMs actually work to lower the price set by the manufacturer by negotiating the best possible price for patients.

Sometimes lower prices are achieved through generic substitutions, when available and medically appropriate, and sometimes it’s through fostering competition when more than one clinically equivalent brand-name drug is available.

A person might not know that a just-as-effective generic might be available at a much lower price—but a PBM will, and they use that knowledge to achieve better pricing. In fact, it’s estimated that PBMs save the state of Florida $43.4 billion in prescription drug costs.

Again, if Florida’s lawmakers are to address the rising costs of prescription medications, it is our hope that they do so keeping in mind the facts and who is actually working to keep drug prices down.

PBMs, through their negotiating function, have served to limit the upward climb of drug costs. Losing sight of that benefit in any reform efforts could cause prices to spiral out of reach for those who need it most.

Jim Maxwell is the vice-chairman of Floridians for Government Accountability.