Coalition Launches to Reform Pharmacy Benefit Manager Practices

Six national organizations, representing patient counselors, patient advocates, those responsible for patient treatment options, and providers of prescription drug benefits to employees and their families, have teamed up to form a new coalition with the goal of bringing transparency to the practices of pharmacy benefit managers (PBMs).

The Coalition for PBM Reform consists of independent pharmacies, grocery stores, small businesses, health care providers and patients. The founding members are the National Community Pharmacists Association, FMI – The Food Industry Association, the AIDS Healthcare Foundation, the National Federation of Independent Business, the Coalition of State Rheumatology Organizations and the Community Oncology Alliance.   

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

The group continued: “The three largest PBMs are all Fortune 15 companies. They control nearly 80% of 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.”

“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,” said Leslie G. Sarasin, president and CEO of Arlington, Va.-based FMI. “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 anticompetitive 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.”