Missing from the PBM hearings: value-based drug reimbursement

This week, committees in both the Senate and House of Representatives used their power to shine a light on one of the most complex and opaque parts of the prescription drug equation: the practices of pharmaceutical benefit managers.

These third-party companies are hired by Medicare, Medicaid, and commercial health plans to create and manage pharmaceutical benefits for more than 266 million Americans. They determine what drugs are covered in their formularies, negotiate prices for these drugs with their manufacturers, set copays for consumers, determine which pharmacies will be included in prescription plans, and decide how much pharmacies will be reimbursed for the drugs they sell.

The committees were particularly interested in two confusing and potentially troublesome PBM tactics: the rebates they negotiate with drug companies and the way they pay pharmacies.