The Health Wonk Shop: Probing the Power and Practices of Pharmacy Benefit Managers

Pharmacy benefit managers (PBMs) are increasingly scrutinized intermediaries in the U.S. health care system, negotiating discounts on prescription medications for health insurers and employers while collecting rebates from drugmakers.
Even as PBMs have taken on a larger role in drug coverage and pricing in recent decades, including through mergers with insurers, the business arrangements that shape their finances remain unusually opaque. That has led to questions about the role PBMs play in the rising cost of prescription drugs, investigations by Congress and the Federal Trade Commission into PBMs business practices, and federal and state efforts to regulate those practices and require greater transparency.
On June 14, two experts joined KFF’s The Health Wonk Shop and series moderator Larry Levitt in a 45-minute discussion about the power and practices of PBMs, addressing such questions as:
How do PBMs make money?
What role do PBMs have in drug costs?
What legislation or other reforms are being considered, and how would they affect consumers?
Moderator
- Larry Levitt, Executive Vice President for Health Policy, KFF
Panelists
- Jennifer Reck, Director, Center on Drug Pricing, National Academy for State Health Policy
- Karen Van Nuys, Executive Director of the Value of Life Sciences Innovation Program and Senior Fellow, University of Southern California Schaeffer Center for Health Policy and Economics
KFF’s virtual Health Wonk Shop series features in-depth policy discussions with experts that go beyond the news headlines to provide greater insights.