Side Effects: The role of the PBM

They certainly don’t carry the same brand recognition as Coca-Cola, McDonalds, or even pharmaceutical giant Pfizer, but last year the largest pharmacy benefit manager in the country reported nearly as much revenue as those three companies combined.

With $102 billion in revenue in 2015, Express Scripts Inc. is a giant in the pharmaceutical supply chain and, according to critics and supporters alike, plays a major role in how drugs are priced in this country.

Their media savvy Chief Medical Officer isn’t shy about telling anyone willing to listen his company is consistently saving patients loads of cash. Yet a lawsuit filed this year against Express Scripts suggests, according to plaintiffs, some patients could be paying more than the competitive rate for common drugs.

When we asked University of Colorado Skaggs School of Pharmacy Professor Robert Valuck if patients can have a discussion about drug costs in 2016 without mentioning the role of PBMs, he gave us a succinct answer.

“Not fully you can’t,” he said.

Not when they’re such an integral part in the drug supply chain.

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