Escalating Battle Between Pharma Companies and PBMs in Washington
Key Points:
* PhRMA prioritizes protecting patient interests from PBM profits.
* PBMs, such as CVS Caremark, defend their role in reducing healthcare costs.
* Bipartisan scrutiny of PBM operations and rebate strategies intensifies.
* New models like Walmart's $4 generics and GoodRx coupons challenge traditional PBM models.
Policy Priorities and Industry Response
The Pharmaceutical Research and Manufacturers of America (PhRMA) has released its 2025 policy priorities, advocating for prioritizing patient welfare over PBM profitability. In response, PBMs have emphasized their value in lowering branded drug costs.
PBM Scrutiny and Rebate Strategies
Recent research suggests that higher PBM rebates may lead to increased list prices and patient out-of-pocket expenses. This has led to increased scrutiny of PBM practices and investigations into their favoritism of high-list price drugs with higher rebates.
Alternative Prescription Access Models
The emergence of alternative prescription access models, such as Walmart's $4 generics, GoodRx coupons, and telehealth partnerships, has created competition for PBMs. CVS has launched its own low-cost prescription program, CostVantage.
Ongoing Relevance of PBMs
Despite the availability of new access models, PBMs remain essential for health insurance companies. In 2024, PBM業務是 CVS 收入最大部分門，共產生 $1780 億美元。