Rising Prescription Drug Prices
The Rising Prescription Drug Prices Medications in the United States has been a source of concern for many, as costs have surged nearly 300% in the past three decades. According to the Federal Trade Commission (FTC), the revenue of the four largest Pharmacy Benefit Managers (PBMs) exceeds $1 trillion, and they control 86% of the market. These middlemen, responsible for negotiating drug prices, are believed to be contributing significantly to the rising costs of medications that patients ultimately pay for. In particular, patients are experiencing increased out-of-pocket expenses, with many struggling to afford necessary treatments.
Rising Prescription Drug Prices Patients’ Struggles and Possible Solutions
Individuals like Cole Chapman, who suffers from an irregular heartbeat and relies on multiple medications to stay healthy, have felt the effects of these rising prices. Chapman previously paid about $300 a month for his medications through his insurance plan, but he managed to cut his expenses by half after seeking care from Dr. Sandra Rosado, a doctor in Seneca, South Carolina. Dr. Rosado runs a practice that avoids insurance companies and focuses on offering patients more affordable generic medications.
Chapman was surprised to find that his out-of-pocket costs were much lower than he had anticipated. Similarly, April Cope, who needs an annual infusion for her osteoporosis, was shown by Dr. Rosado that the generic version of her medication cost $120, while the brand name version was priced at $1,300. Despite these savings, many patients still face barriers in accessing cheaper generic options, largely due to PBMs steering them toward the more expensive brand-name drugs.
The Influence of Pharmacy Benefit Managers
Pharmacy Benefit Managers are at the heart of the issue, often preventing patients from receiving the more affordable generic alternatives. According to the FTC, Rising Prescription Drug Prices PBMs exert control over which drugs are covered, sometimes forcing patients to purchase the more expensive brand-name drugs, even when a generic option is available. These middlemen are incentivized by rebate deals offered by drug manufacturers, who provide discounts to PBMs for exclusive access to brand-name drugs. These rebates can drive up the price of medications for patients, as PBMs often keep a portion of the savings rather than passing them on to the consumers.
Additionally, PBMs can direct patients to specific pharmacies, including those with higher prices, further increasing the financial burden on patients. One FTC report highlighted a case where a woman’s breast cancer treatment cost an extra $2,000 because the pharmacy with the lower price was not covered by her plan.
While PBMs argue that they are working to lower costs, patients like April Cope find themselves frustrated by the increasing prices. “When healthcare costs are skyrocketing, it’s frustrating. Nobody can pay those costs on an ongoing basis,” Cope said. The situation is exacerbated by the lack of transparency regarding the allocation of rebate dollars, which often do not reach the patients who need them most. Instead, PBMs continue to hold onto significant portions of these rebates, contributing to the growing costs of healthcare in the country.
