Arizona Patients Before Profits
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Arizona's Patients Should Take Priority Over Corporate Profits
Protect Patient Choice
Stop Patient Steering Practices in Arizona
Arizona patients deserve the highest quality healthcare. When it comes to prescription medication, our state's patients deserve the right to choose their own pharmacy; not be forced to endure long drives, substandard service, or mail order dangers just to have their prescribed medication covered by their own health plan.
What is a PBM?
Pharmacy benefit managers (PBMs) are middlemen that sit between drug manufacturers and pharmacies. Originally created as paper pushers to process prescription drug claims, PBMs do not manufacture or distribute medications, and they are not healthcare professionals. The largest PBMs are owned by the nation's largest health insurance corporations.
What Does a PBM Do?
PBMs: > Determine a patient's copay > Determine which medications are covered under a patient's plan formulary > Pre-determine how much each drug on the fomulary will cost and the amount the PBM will reimburse the pharmacy and/or provider
What is a Drug Rebate?
In the prescription drug market, a rebate is money paid by the drug maker to the pharmacy benefit manager (PBM) for placement on a health insurance plan's formulary. PBMs negotiate manufacturer rebates - which they keep in part or whole. The more expensive the medication, the higher the rebate. PBMs will often structure their contracts to allow them to collect and keep rebates as part of an “administrative fee” or “rebate sharing” arrangement with the health insurance plan instead of passing the rebate to its rightful owner - the purchaser of the prescription. Since the largest PBMs are owned by the largest health insurance companies, this "rebate sharing" arrangement is a funnel directly back into the corporation's own pockets. Patients never see a dime.
What is a Formulary?
A formulary is the list of prescription drugs that a health insurance company has agreed to cover on behalf of their plan members. PBMs determine and control these "approved drug lists" for each healthcare plan they represent and update or change them on a regular - in many cases random - basis.
How Do PBMs Affect Me?
Visit our FAQ section below to learn more about PBM practices and how they affect your health.
