Study: PBMs setting wildly variable prescription prices for patients at the counter

Author: APCI Staff/Tuesday, September 19, 2023/Categories: APCI News, Legislative Affairs

Bessemer, AL (Sept. 19) – The country’s largest pharmacy benefit managers (PBMs) are setting drug prices for patients at the pharmacy counter, and they are literally all over the map, according to a new study released today.

While large PBMs and their lobbying arm constantly assert that drug manufacturers alone set prescription prices, the study – “Unraveling the Drug Pricing Blame Game” – finds that most prices paid by patients at the pharmacy counter are “based on price points established by the drug supply chain intermediaries known as pharmacy benefit managers (PBMs).” Additionally, the study reveals wild swings in prescription pricing set by PBMs and charged to patients.

Image of the front page of the one-pager discussing the 3 Axis Advisors report on PBM pricing

Click the image above or here to open a downloadable, printable one-pager that discusses the report to share with your elected officials.

The study was performed by data analytics firm 3 Axis Advisors and was sponsored by American Pharmacy Cooperative, Inc. (APCI).

The study is replete with examples of variability and the arbitrariness of PBM-set drug prices. In one example, the report identified the same PBM, on the same day, setting prices at the same community pharmacy, for the same anti-depressant medication at five different price points ranging from $9.30 to $96.00. This was no aberration. The study also found multiple examples of drugs for which there were no changes to drug’s acquisition cost, but which saw numerous and indiscriminate price points set by the PBMs. For example, generic arthritis medication meloxicam, in a 15 milligram tablet form, saw more than 117 different price points over the course of a year. Prices for patients ranged from a low of less than one dollar to more than $200 per prescription despite meloxicam’s National Average Drug Acquisition Cost (NADAC) price remaining low and unchanged throughout the year.

“The findings of this study should raise alarm bells for every American. The largest PBMs in the world are setting drug prices and they are seemingly making it up as they go along,” said APCI’s General Counsel and Director of Healthcare Policy Greg Reybold. “The report’s findings reveal disturbing trends including PBMs increasing prescription prices when patients are paying out of pocket and massive variability and price swings when there is little to no variation based on the NADAC. Simply put, the system is broken, and PBMs can no longer be trusted to set drug prices.”

“Attention to PBM practices has never been greater with more than forty drug pricing bills in Congress, the FTC’s 6b study, and recent reports from MedPAC and the GAO,” said APCI CEO Tim Hamrick. “However, this report tells a story that hasn’t been told before and we commend 3 Axis Advisors for their work. We believe this report removes all doubt as to the PBM industry’s involvement in the establishment of prescription pricing. We also hope this report spurs Congress to action to change the pharmacy reimbursement model for the benefit of patients, taxpayers, and community pharmacies.”

About APCI

APCI is a cooperative of more than 1,600 independently owned community pharmacies in 31 states. Established in 1984 and headquartered in Bessemer, Ala., APCI is recognized as a leader in the fight for prescription drug pricing transparency and reform.

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