When the $10K brand name drug is more af­ford­able than its $450 gener­ic: How PBMs con­trol the sys­tem

Phar­ma­cy ben­e­fit man­agers — the much-ma­ligned mid­dle­men be­tween drug man­u­fac­tur­ers and health in­sur­ers — of­ten tilt the mar­ket, 80% of which is con­trolled by 3 of the largest PBMs, in their own and un­usu­al ways.

These games, like claw­ing back mon­ey af­ter a pre­scrip­tion has been dis­pensed, or of­fer­ing re­im­burse­ments that don’t cov­er the cost of what phar­ma­cies pay for a drug, were on full dis­play at Thurs­day’s meet­ing where the Fed­er­al Trade Com­mis­sion de­bat­ed whether to look in­to these PBMs, some of which have grown so big to be on the For­tune 15.

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