A new paper from the American Medical Association (AMA) has found that the pharmacy benefit manager (PBM) marketplace remains highly concentrated, with just a few major players controlling most of the activity. Many of these PBMs are vertically integrated with health insurers, raising concerns about limited competition and potential conflicts of interest.
The AMA study analyzed key PBM functions – including rebate negotiation, retail network management, and claims adjudication – and found that local markets are generally dominated by a small number of PBMs. Nationally, 77% of individuals enrolled in prescription drug plans are covered by an insurer that also owns or is affiliated with a PBM.
“These are important findings,” the AMA stated, “because low competition may lead to higher prices paid by insurers for PBM services, higher insurance premiums, PBMs not fully passing rebates through, and lower reimbursement to pharmacies.”
As scrutiny of PBM practices grows, MedBen Rx stands apart by offering total transparency into drug pricing and pharmacy benefit services. We return all paid rebates to the plan and ensure you know exactly where your pharmacy dollars are going – and why.
Contact your MedBen representative or broker to learn how MedBen Rx can bring greater clarity and savings to your pharmacy plan.