PBM industry report claims greater use of tools can generate $1T in savings over next decade
Summary
“As this analysis indicates, with even greater use of PBM tools, we can achieve more market-based savings to further reduce drug costs for every patient,” said JC Scott, president and CEO of the PCMA, in a statement. RELATED: CAQH CORE approves 2-day limit for health plans to act on prior authorizations The study looked at federal drug spending projections from 2018 to 2029 and evaluated the share of out-of-pocket costs associated with copays for prescriptions linked to PBMs and PBM tools. “This is a desperate report to basically try to go against the tide to say don’t restrain us,” said Ted Okon, president of the Community Oncology Alliance, which represents cancer patients and independent oncologists. The Trump administration also proposed removing the anti-kickback safe harbor for Part D rebates but backed off after concerns about the effect on plan premiums. Okon said cancer patients are hurt by formulary management tools such as prior authorization and step therapy that delay or deny access to medication, and the study wants to double down on such tactics.