top of page

Delinking Medicare Prescription Costs from PBM Profits Protects Seniors

Our prescription drug pricing system in America is complex, confusing and often puts patients at a disadvantage. Insurance middlemen pharmacy benefit managers – or PBMs – have found ways to profit from this system at the expense of patients – especially seniors on Medicare.


PBMs are essentially gaming the system, generating profits from the rebates they demand from pharmaceutical manufacturers – the higher a drug’s list price, the larger the rebate – and incentivizing themselves to steer patients toward higher-priced drugs. PBMs and their affiliated insurance companies can use control of drug formularies to block access to lower priced generics and biosimilars and force seniors to purchase more expensive drug options.


Fortunately, some leaders in Washington are working on legislative solutions to help lower out-of-pocket costs for our most vulnerable citizens. Lawmakers on both sides of the aisle are advocating legislation that would delink PBM profits from drug prices, paying PBMs a reasonable flat fee for the services they provide but eliminating the incentives that result in exorbitant PBM profits at the expense of patients and consumers.


To learn more about efforts to delink PBM profits from prescription costs, click here.


bottom of page