PBMs Increasing The Price of Epipen And Insulin
Pharmacy Benefit Managers and the High Cost of Epiens: An Overview
Pharmacy Benefit Managers (PBMs) are third-party administrators of prescription drug programs for health plans, insurance companies, and self-insured employers. PBMs negotiate drug prices with manufacturers and set reimbursement rates for pharmacies, and are therefore instrumental in determining the cost of prescription drugs. In recent years, the high cost of certain prescription drugs, including Epipens, has been linked to the practices of PBMs.
Epipens are devices used to administer epinephrine in cases of severe allergic reactions. The cost of Epipens has risen dramatically in recent years, from around $100 for a two-pack in 2009 to over $600 in 2016. This steep increase in cost has led to concerns about access to lifesaving medication for patients with severe allergies.
One factor contributing to the high cost of Epipens is the role of PBMs. PBMs negotiate prices with drug manufacturers and set reimbursement rates for pharmacies, and they have been accused of using their market power to drive up prices for medications like Epipens. PBMs may negotiate lower prices with drug manufacturers, but then charge higher prices to health plans or employers, effectively increasing the cost of medications for patients. Additionally, PBMs may favor certain medications over others based on factors such as rebates, which can lead to higher costs for patients.
In the case of Epipens, PBMs have been accused of favoring Mylan, the manufacturer of Epipens, over competitors. Mylan reportedly paid PBMs large rebates in exchange for preferential treatment in formularies, which are lists of medications that are covered by a particular health plan. This means that patients were more likely to be prescribed Epipens, even though there were other, less expensive alternatives available.
The high cost of Epipens is not an isolated issue, and PBMs have been linked to other cases of increased drug prices. For example, PBMs have been accused of contributing to the high cost of insulin, which is essential for the treatment of diabetes. Like Epipens, the cost of insulin has risen significantly in recent years, making it difficult for many patients to afford.
While PBMs play an important role in managing prescription drug programs, their practices have come under scrutiny in recent years. Critics argue that PBMs lack transparency and accountability, and that their practices contribute to the high cost of prescription drugs. Some have called for increased regulation of the PBM industry to ensure that patients have access to affordable medications.
In conclusion, the high cost of Epipens and other prescription drugs is a complex issue that involves many factors, including the role of PBMs. PBMs have been accused of contributing to the high cost of Epipens and other medications through practices such as preferential treatment for certain manufacturers and the use of rebates. As the debate over prescription drug costs continues, it is important to consider the role of PBMs in the pricing of medications and to advocate for greater transparency and accountability in the industry.
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