The Real Problem: When Middlemen Create a Void and then Claim Credit for Filling It

Pharmacy benefit managers (PBMs) are once again resorting to misleading claims in a continued effort to deflect from the growing scrutiny their industry faces – from investigations and legal challenges to bipartisan calls for meaningful reform. This time, the PBMs’ national trade organization, PCMA, is mischaracterizing the conclusions of a recent report around commonly used asthma medication. 

PCMA is once again predictably misrepresenting the true drivers of inhaler list prices – deflecting from the central role PBMs play in inflating costs through rebate structures, administrative fees and other profit-driven mechanisms that ultimately drive up prices for patients. 

The reality is that PBMs ultimately determine patient access to medicines and how much patients pay. Too often, PBM decisions are shaped not by therapeutic need, but by whether a rebate arrangement was in placethat would benefit the middlemen. 

• An update from Allergy & Asthma Network about federal $35 caps for inhalers notes that manufacturers “cannot control any inhaler fees added on by PBMs,” explicitly flagging that PBM charges are layered on top of these lower prices.​ 

• The 2024-2025 inhaler price caps and copay programs show that when manufacturers drop out-of-pocket obligations to $35, many patients still struggle due to PBM fees, formulary exclusions and benefit design that keep total out-of-pocket costs high. 

• Health Affairs reports that confidential rebates on brand-name inhalers had reached about 50-70% of list price prior to 2024, meaning PBMs and plans were operating in an environment where net prices were far lower than what patients’ cost-sharing was based on. 

This is not an isolated pattern. A bipartisan Senate Finance Committee investigation into insulin pricing found similar dynamics: PBMs were securing rebates as high as 60% on certain insulin products, while the PBM or health plan determined formulary placement and cost-sharing responsibility. 

PCMA’s latest attempt to deflect with misleading claims is yet another way that PBMs are trying to divert attention from their harmful practices instead of lowering out-of-pocket costs for Americans. And it further reinforces why continuing reforms are needed.  

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