"More and more scrutiny is being directed towards PBMs, and so, as this purported leaked memo makes clear, they're having to scramble to preserve the status quo, and, as the memo suggests, they've got deep pockets to do it. That's because they've extracted untold profits from patients, drug manufacturers and health plans, and they do it with very little oversight and almost no transparency. PBMs' business model is contributing to the problem of rising drug costs—as well as the resulting medication access and affordability challenges those costs create for patients.
"As evidence, consider their manipulation of pharmacy DIR (direct and indirect remuneration) fees in the Medicare Part D space. NCPA wholeheartedly agrees with Medicare officials that PBM manipulation of pharmacy DIR fees increases costs to the government and raises beneficiary out-of-pocket costs for medications. Those retroactive fees also threaten the viability of some independent pharmacies. The growing PBM share of rebates from drug manufacturers is another example of how PBMs profit right along with higher prices. We need PBM reform in order to help patients and health plan sponsors."