PBM association begins ad campaign to defend industry's role

The Pharmaceutical Care Management Association, which represents PBMs, has launched a significant digital advertising campaign designed to, in their words, educate on the role pharmacy benefit companies play in securing savings and provide choice and expertise for employers about prescription drug benefit design and coverage.

PBMs have faced significant scrutiny as many accuse them of anticompetitive practices and of being part of the problem of high drug prices. Recently, at a congressional hearing, senators and witnesses portrayed the large PBMs as working against the interests of consumers. Efforts at the both the federal and state level aim to put restrictions, and some states are succeeding in placing new requirements on PBMs, including new licensing and reporting requirements, prohibitions on spread pricing and rules that are aimed to make costs more transparent enrollees.

As part of the campaign, PCMA launched targeted ads in the District of Columbia and in key states “educating on the negative repercussions of misguided policies for patients, taxpayers and employers,” Greg Lopes, assistant vice president of strategic communications for PCMA, told Formulary Watch. “The PCMA ads call on Congress, as well as others in the public and private sector, to unite around tangible solutions — many of which are already on the table in the Senate — that drive competition in the prescription drug marketplace and lower costs for patients.”

PCMA officials say pharmaceutical companies are the ones responsibility for high costs. Any conversation about lowering prescription drug costs must start with drug companies, “which means holding big drug companies accountable for common patent abuses which block competition and keep prices high,” Lopes said.

National Community Pharmacists Association Chief Executive Officer B. Douglas Hoey, R.Ph., told Formulary Watch he believes the new ad campaign is a result of PBMs “feeling the heat from decades of work by NCPA…joined by consumers, employers, physicians, and other pharmacy groups. They’re even using this campaign to attempt to change how they’re referred to (pharmacy benefit companies versus pharmacy benefit managers) and continue trying to confuse and minimize their role in the healthcare system,” Hoey said.

PBMs do indeed manage prescription drug plans, Hoey said. “They control what drugs are covered on patients’ plans and how much they’ll pay for them, steer patients to pharmacies they own or are affiliated with, and determine how much or how little pharmacies will be reimbursed.”

Ryan Oftebro, Pharm.D.

At the hearing, a Seattle-based pharmacist described how PBMs used deceptive practices to over-inflate the price of a generic medication. Ryan Oftebro, Pharm.D., owner of Kelley-Ross Pharmacy Group, testified that PBMs increased the patient co-pay for a common generic cholesterol medication from $15 to $141 for the same 90-day supply, costing his patients an extra $500 out-of-pocket per year. The “overpayment” was then clawed back by the PBM, and not given back to the patient, he said.

Ultimately, $538,000 in retroactive fees forced the closure of one of his locations that had served a neighborhood for decades. “There’s obviously no way that a business could operate with these predatory and unpredictable fees. So, we made the difficult decision to close this location in 2022,” Oftebro said.

In a blog post, JC Scott, president of chief executive office of PCMA, said the independent pharmacy marketplace is stable. “The total number of independent pharmacies has increased by 7.5% over the last 10 years and in the last five years, the number of stores has fluctuated marginally year-to-year, sometimes gaining and sometimes losing,” he said.