SPRINGFIELD, Ill. (WAND) — A new federal report shows the people responsible for negotiating drug discounts from manufacturers have actually increased the costs of prescriptions and left Americans with fewer choices. Illinois leaders said Tuesday they are committed to ensuring people have more choices for filling their prescriptions.
The top three pharmacy benefit managers control 80% of the prescription volume in the United States, according to the Federal Trade Commission. New data show the six largest PBMs process a total of 94% of the prescriptions across the country. Their corporate organizations include insurance companies, healthcare providers and drug manufacturers.
"The healthcare conglomerates appear to be driving growth by generating increasing levels of revenue from their vertically integrated affiliates," said Ann Gillespie, acting director of the Illinois Department of Insurance. "Said another way, these corporations are growing by paying their own companies more and more."
Gillespie said she will not tolerate consumers receiving less than the value of the benefits they pay for through insurance plans.Â
However, the trade association representing nearly 20 PBMs argued many of the allegations included in the FTC report are based on speculation presented without concrete evidence. The Pharmaceutical Care Management Association said the FTC should conduct a robust analysis on data presented by PBMs before states develop new reforms.
"The FTC fails to reconcile its own position on previous examinations of the PBM industry, specifically PBM ownership of mail order pharmacies," said Connor Rose, the PCMA senior director of state affairs. "That study demonstrated that PBM-owned mail order pharmacies actually do provide value to customers. They do provide value to plan sponsors in the form of lower drug costs."
The top three pharmacy benefit managers control 80% of the prescription volume in the United States, according to the Federal Trade Commission.
Experts said long-term care pharmacy members are not able to speak publicly on this issue due to fear of retribution from PBMs. Chad Warz, CEO of the American Society of Consultant Pharmacists, said pharmacies across the country are closing every day due to this challenge.
"PBMs have used their massive power to punish pharmacies as they grow rich on the backs of independent small businesses and patients who continue to struggle to afford their life saving and life improving medications," Warz said.
Lawmakers could pass a PBM reform plan during veto session this fall. The General Assembly is scheduled to reconvene on November 12.
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