Opinion: Imagine there are no PBMs. It’s easy if you try
Americans are divided on many fronts: tariffs, building walls, and how to fix our broken health care system are just a few of them. One front that many seem to agree on is the replacement of outdated health care institutions, like pharmacy benefit managers, which cause market inefficiencies that result in skyrocketing medication costs.
Pharmacy benefit managers function the way travel agents used to, and benefit from price inflation. Replacing travel agents with a per-click transactional model opened up airline markets, and there’s likely nothing to prevent Amazon and others from bringing the same efficiencies to the drug world.
If you doubt that pharmacy benefit managers could go the way of the travel agent, start with this statistic: About 9 out of 10 in the United States are for generic medications, and these in the aggregate consume about . Purchasers could buy these directly from the generics manufacturers for about a third of that and just give them away. Next, they could “go direct” for the 1 in 10 branded drug purchases by removing rebates.
