Pharmacy benefit managers and drug affordability policy proposals for enhancing access in underserved communities

Abstract

Listen

Translate article

Pharmacy Benefit Managers (PBMs) play a pivotal role in the pharmaceutical supply chain, yet their practices have increasingly contributed to the rising costs of prescription drugs and limited access to essential medications, particularly in underserved communities. This paper critically examines the role of PBMs, highlighting their challenges to drug affordability and accessibility. It explores the limitations of existing policies and proposes comprehensive reforms to enhance transparency, accountability, and fairness in PBM operations. The proposed policy interventions include mandatory transparency in PBM rebates and formularies, regulations on rebate retention, and fair reimbursement rates for pharmacies. Additionally, broader strategies such as government regulation of drug prices, expanded subsidies for low-income populations, and value-based contracts are discussed as potential solutions. The paper concludes with recommendations for policymakers, healthcare providers, and PBMs, emphasizing the need for collaborative efforts to ensure the successful implementation of these reforms. Addressing the issues posed by current PBM practices, these policy proposals aim to significantly improve drug affordability and access in underserved communities, ultimately contributing to a more equitable healthcare system. Keywords: Pharmacy Benefit Managers (PBMs), Drug Affordability, Healthcare Access, Underserved Communities, Policy Reform, Pharmaceutical Supply Chain.