Untangling The $500 Billion PBM Web: The Opaque Relationship Between Employers And Drug Middlemen

Rita Numerof

On the heels of the FTC’s investigation into pharmacy benefit managers for what many regard as anti-competitive business practices, legal pressure is continuing to mount. At least six state Attorneys General, including California, Ohio and most recently Vermont, have initiated lawsuits against PBMs. Additionally, recent House oversight investigation findings bolster these claims, revealing that these drug middlemen–who claim to control costs–have instead “steered patients toward higher-priced medicines and affiliated pharmacies.”

As these inquiries, investigations and lawsuits keep PBM practices in the public eye, it’s important that lawmakers, employers and the general public understand not just what these practices are but how they relate to the larger healthcare market. PBMs are one piece of the jigsaw puzzle of healthcare, and they affect consumers’ cost and quality of care. For employers, the relationship with PBMs is complex and often …

Healthcare’s Hidden and Unnecessary Fees

By Chris Faddis

Experiences like Tim Ebel’s are unfolding every day, all across our nation and they highlight an urgent problem with our healthcare system: a gross lack of transparency which leads to out-of-control healthcare costs that have nothing to do with the care provided. Tim’s visit to an ENT specialist cost him $993 – $348 to see the specialist and an extra $645 just for stepping foot into the medical office building.

This additional cost, in this case known as a ‘facility fee,’ gets charged to patients after their visit simply for using the building where the appointment/operation occurred. These outrageous fees cannot be contested by the patients, and insurance does not cover them. From routine checkups to complex surgeries, American’s are being surprised with these and other unnecessary fees. …