Sep 23, 2021

Patient advocates, doctors, pharmacy, retail, healthcare, small business groups say underwater reimbursements, patient steering, and other PBM practices restrict patient access and increase costs


Washington, DC – Six national organizations – representative of patient counselors, patient advocates, organizations responsible for patient treatment options, and groups that provide prescription drug benefits to employees and their families – joined forces today as a new coalition aimed at bringing transparency to a part of the health care system dominated by a few giant corporate middlemen with opaque business practices.

The Coalition for PBM Reform which represents independent pharmacies, grocery stores, small businesses, healthcare providers, and patients, is the largest and most diverse effort yet to change the way pharmacy benefit managers (PBMs) operate. The members include: the National Community Pharmacists Association (NCPA), FMI – The Food Industry Association (FMI), the AIDS Healthcare Foundation (AHF), the National Federation of Independent Business (NFIB) the Coalition of State Rheumatology Organizations (CSRO), and the Community Oncology Alliance (COA).    

“Our organizations represent millions of patients, hundreds of thousands of employers, and thousands of healthcare providers whose access to medicine is threatened by a hand full of companies that dominate the prescription drug industry. These companies decide prescription drug benefits, set prices, limit access, and threaten the viability of local healthcare providers. Moreover, they do so without treating or counseling a single patient, and without providing insurance coverage to a single employee or family.

“The three largest PBMs are all Fortune 15 companies. They control nearly 80 percent all prescriptions filled in the United States. Since they work for the largest insurance plans, public and private, their practices affect the cost of prescription drugs for most Americans and most employers. Nevertheless, they operate far outside of the public view. In fact, the terms they impose on patients, providers, and employers are negotiated completely without scrutiny. Transparency and information are the keys to any healthy market. They form the basis on which consumers can make decisions. Those elements are largely absent from the prescription drug market, and this coalition aims to change that.”

Leslie G. Sarasin, president and CEO, FMI – The Food Industry Association, said:

“As the food industry association, FMI works with and on behalf of the entire industry – from retailers and wholesalers to product suppliers – to advance a safer, healthier and more efficient consumer food supply chain. Our members’ retail stores include 10,000 supermarket pharmacies providing the full array of health and well-being tools that are so important to our customers. Unfortunately, despite their essential role during the COVID-19 pandemic, supermarket pharmacies are struggling to stay in business due to the anti-competitive practices of PBMs. We look forward to working with the diverse group of organizations making up the Coalition for PBM Reform to collectively seek greater transparency in the way PBMs operate that will benefit patients, health care providers, employers and pharmacies alike.”

For more information about the Coalition for PBM Reform, please visit www.PBMfacts.com.