“There is growing awareness of the problems and pitfalls with Pharmacy Bene t Managers (PBMs)
in the United States health care system. Contracted by insurance carriers to negotiate on their
behalf with pharmaceutical companies, these ‘middle men’ corporations have quietly become an
unavoidable part of our nation’s health care system. Controlling at least 80 percent of drug bene ts
for over 260 million Americans, PBMs have the power to negotiate drug costs, what drugs will be
included on plan formularies, and how those drugs are dispensed. Oftentimes, patients are required
to receive drugs through PBM-owned specialty pharmacies.
However, while the role PBMs play in the U.S. health care system is complex and under scrutiny
by policymakers and the public, with much of the debate focusing on economics, little discussion
takes place of the impact PBMs have on patients.
This paper is the first in a series that will focus on the serious, sometimes dangerous, impact PBMs
are having on cancer patients today. These are real patient stories but names have been changed
to protect privacy.”