Pharmacy benefit managers (PBMs) are a key part of the health care system, working with health plans and the employers who provide health benefits to their employees to help drive down the prices of prescription drugs. Drug spending – which is primarily driven by high-cost specialty drugs – continues to grow, totaling $301 billion in 2021, which is up 43% since 2016.
Research finds that PBMs can save payers and consumers $654 billion in prescription drug costs between 2016 and 2025 while playing a key role in expanding access to life-saving drugs.
“Not only do PBMs negotiate better net prices from drug manufacturers and pharmacies, they also reduce waste, improve medication adherence, encourage the use of generics and affordable brands, offer more convenient delivery, and drive quality rather than quantity of care,” said Adam Kautzner, President of Express Scripts, the PBM division of Evernorth Health Services. “The cost savings that come from PBMs are critically important to more than 266 million patients across the United States.”
Here are some facts about the role that PBMs play in driving prescription drug affordability and access.
PBMs Offer Stability in a Time of Uncertainty by Driving Down Costs for Consumers
In today’s economic environment, the average American household is spending almost $445 a month more for consumer goods than a year ago. Recognizing the important role that prescription drug affordability plays in access and in improving health outcomes, Express Scripts has introduced a new and innovative solution, the Copay Assurance Program, capping out-of-pocket costs for people whohave employer-sponsored health insurance.
This means customers of the program will pay no more than $5 for generics and specialty generics, $25 for preferred brand drugs, and $45 for preferred specialty brand drugs every time they fill a prescription. The program will immediately guarantee these lower out-of-pocket rates – customers will not have to wait to meet any deductible levels. Members can save more than 25% at the pharmacy counter.