The lack of regulation in the PBM market has allowed the major PBMs to form plans to use the PBMs’ own mail-order and specialty pharmacies. Substantial conflicts of interest arise when a PBM owns its own pharmacy operations. Its incentives shift from negotiating the lowest cost method of drug distribution to driving profits from its own pharmacy operations, and thereby effectively forcing payors and consumers into using the PBM-owned mail order, specialty, or retail pharmacies.
Consumers strongly prefer dealing with a community pharmacist and especially for specialty pharmaceuticals, the pharmacist provides invaluable counseling and patient monitoring.
In addition, PBM owned mail orders often increase utilization and costs by dispensing unnecessary drugs.
The conflict of interest denies consumers access to quality health care and increases the cost of overall health care to plans and consumers.
Consumers strongly prefer dealing with a community pharmacist and especially for specialty pharmaceuticals, the pharmacist provides invaluable counseling and patient monitoring.
In addition, PBM owned mail orders often increase utilization and costs by dispensing unnecessary drugs.
The conflict of interest denies consumers access to quality health care and increases the cost of overall health care to plans and consumers.