Pharmacy benefit managers (PBMs) "have evolved from their original role of claims processors into the unauthorized practice of medicine and pharmacy," a National Community Pharmacists Association (NCPA) official charged in a stern warning to Washington policy makers, who are being lobbied heavily by representatives of the PBM industry.
"PBMs dictate what medication the patient may have, based on special payments the PBM receives, not on the basis of the patient's health status," NCPA Government Affairs Vice President John Rector said.
Rector's concerns about PBM practices are shared by a large number of independent pharmacy owners across the country. During a recent NCPA government affairs conference in Washington, DC, the conduct of PBMs emerged as the top complaint among the pharmacists in attendance.
Although PBMs justify many of their practices as necessary for holding down the cost of drugs, NCPA officials contend that these "middlemen" actually drive up the cost of medicine. "Despite PBM claims of reducing the cost of prescription benefits, prices have increased more than 16.8% in 1998, 14.2% in 1999, 16.3% in 2000, 16.9% in 2001, 18.4% in 2002, 19.5% in 2003, and an estimated 18.1% for 2004," Rector said.