The Hidden Forces Behind Skyrocketing Prescription Prices
If you’ve ever wondered why prescription prices seem to rise endlessly, you’re not alone. For years, the answer has remained hidden in plain sight: PBMs, or pharmacy benefit managers. These middlemen claim to negotiate drug prices on your behalf, but the reality is much more complex and damaging.
According to the U.S. Federal Trade Commission and attorneys general from at least eight states, PBMs are a primary driver of higher drug costs. They’ve drawn national attention, and their practices are the focus of an upcoming documentary, Modern Medical Mafia: An Attack on the American Dream, premiering January 21 on Amazon.
What Are PBMs, and Why Should You Care?
PBMs sit between drug manufacturers and pharmacies, controlling which medications are covered by insurance plans and negotiating rebates and discounts. While this might sound beneficial, PBMs are owned by some of the largest health insurance corporations in the nation, including Caremark, Express Scripts, and OptumRX. This ownership creates a profit-driven cycle that leaves patients and independent pharmacies like JJ’s Prescription Specialties bearing the brunt.
PBMs’ practices result in:
Higher Drug Prices
Instead of passing negotiated savings to consumers, PBMs often pocket rebates and profits, driving up out-of-pocket costs.
Pharmacy Closures
Independent pharmacies struggle to compete with PBM-owned mail-order services and restricted reimbursement rates.
Limited Access
Patients are frequently forced to switch medications or use specific pharmacies dictated by PBMs, regardless of convenience or preference.
The Push for PBM Reform
The fight against PBMs isn’t just a business issue—it’s a health crisis. The United States is the only country in the world with PBMs, and it also has the highest prescription drug prices globally. Advocacy groups, independent pharmacies, and policymakers are calling for reform to bring transparency and fairness to this broken system.
Organizations like the National Association of Community Pharmacists (NACP) are working tirelessly to expose PBMs’ harmful practices and advocate for change. Efforts include:
Legislation: Proposals to regulate PBMs’ pricing practices and increase transparency.
Legal Actions: States suing PBMs for anti-competitive behavior and consumer harm.
Public Awareness: Documentaries like Modern Medical Mafia highlight the real-world impact of PBMs on patients and pharmacies.
Why This Matters to You
Higher drug prices hurt everyday Americans, particularly those on fixed incomes or managing chronic conditions. For independent pharmacies like JJ’s Prescription Specialties, PBM practices threaten our ability to serve our community. Our focus has always been your well-being, not corporate profits.
By understanding the role PBMs play in the healthcare system, you can join the call for change. Whether it’s supporting legislative reforms, choosing independent pharmacies, or sharing resources like Modern Medical Mafia, every action counts.
What’s Next?
As the January 21 release of Modern Medical Mafia approaches, stay informed about this critical issue. Follow updates from JJ’s Prescription Specialties and join the growing movement to reform the PBM system. Together, we can make prescription drugs more affordable and protect the independent pharmacies that care for our communities.
For more information, visit us in-store or contact us directly. Your health is our priority, and we’re here to help.