It's time to fix Wisconsin's broken prescription drug system
Pharmacy Benefit Managers (PBMs) are eliminating patient choice, rigging prices, ripping off taxpayers and destroying neighborhood pharmacies. Together, we can improve the quality of healthcare provided by pharmacists, save taxpayers money and restore fairness to the distribution of prescription drugs.
The Impact of PBMs
A Broken System
The Wisconsin prescription drug distribution system is broken, and it’s hurting millions of people every day, including patients, taxpayers and neighborhood pharmacists.
There is a lot about this system that needs fixing, but the biggest culprit? Pharmacy Benefit Managers (PBMs).
What are PBMs?
Prescription drugs are distributed through a complex system. At its center is a shadowy group of powerful middlemen who wield tremendous influence over everything from what you pay for medication to what is approved for your doctor to prescribe you.
PBMs: The Heart of the Problem
PBMs: What They Do
PBMs were created to process prescription drug claims for insurers – including state employee programs – and their plan sponsors. Over time, they have amassed substantial power that goes far beyond that original mandate.
These faceless corporations – three of which control nearly 80% of the market – not only have a hand in setting drug prices every step of the way; they also are involved in making personal healthcare decisions behind closed doors for millions of people who have no say in those decisions.
How You Suffer
Whether you need prescription medication, own a neighborhood pharmacy or simply pay taxes in Wisconsin, the prescription drug middlemen known as PBMs are hurting you every day.
While senior citizens and those who are chronically ill are especially dependent on prescription drugs, most of us rely on them at one point or another. PBMs want you to think they're on your side, but in fact, PBMs:
Keep drug costs high by charging the health plan more than they reimburse the pharmacy, then keep the difference (or "spread") for themselves as profit
Control what drugs your doctors are allowed to prescribe you
Decide where you can go to fill your prescription, and often penalize you for using your hometown pharmacy by threatening higher medication costs if you don't utilize a PBM-owned pharmacy
Influence your insurance plan promising savings by requiring mail order to fill prescriptions when it's often less expensive and far less wasteful for you to use your neighborhood pharmacy