PBMs NOT the friend of consumers

In a Nov. 28 opinion piece on The Hill’s Congress Blog (“PBMs Save us Billions of Dollars”), Jonathan Orszag portrays pharmacy benefit managers (PBMs) as the best friend of consumers. In defending the upcoming merger of two PBMs, Express Scripts and Medco, Orszag claims the transaction will save the health system money. But Orszag seems to lose sight of the interests of the ultimate consumer here — the patient.

Unfortunately, PBMs have acted contrary to the interests of American consumers on too many occasions. Indeed, each one of the major PBMs have been prosecuted by a coalition of state attorneys general for illegally switching patients from their drug of choice to a drug where the PBM pocketed higher rebates. The penalties imposed by the courts have exceeded $370 million in penalties and fines.

PBMs are huge engines for profit in the healthcare industry. In the past few years the profits of the big three PBMs have jumped from less than $900 million to more than $6 billion. The salary of Express Scripts’s CEO George Paz exceeded $57 million last year, making him the fifth highest paid executive in the country.

In claiming to provide great savings and benefits for consumers, Orszag neglects to mention that many PBMs, such as Express Scripts and Medco, often prevent consumers from using the pharmacy of their choice. Thousands of patients are forced to use mail-order service, cannot use the preferred local pharmacy, and are deprived of the ability to make the choice that works best for them or their families.

American consumers deserve to be in charge of their own healthcare decisions. But a merged Express Scripts-Medco could deny thousands more consumers the right to choose where they obtain their prescriptions. Today, Medco is insisting already its patients use mail-order programs and restricting their access to their trusted community pharmacist.

When they act as honest brokers and do not succumb to conflicts of interest, PBMs play an important role in controlling costs in our healthcare system. Unfortunately, it seems that many PBMs have been more focused on enhancing their own profits by restricting consumer choice. One way to slow these recurrent concerns is to promote greater competition in the market.

Americans understand that when consumers have fewer choices, and when competition is reduced, prices go up. That’s where Orszag’s argument falls short. We fear that this is exactly what will happen if the Express Scripts-Medco merger is allowed to move forward.

Greenberg is executive director of the National Consumers League.

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