WHO WE ARE
The PBM Accountability Project of Minnesota brings together patients, advocates, healthcare industry workers, leaders and other stakeholders working to help ensure that Minnesotans aren’t overpaying for the medications they need. We are educating our fellow Minnesotans about the role Pharmacy Benefit Managers (PBMs) play in driving up the cost of medicines, as well as identifying solutions to return savings to patients, employee health plans, and taxpayers. More on the PBM problem HERE.
Our mission is to ensure that Minnesotans can afford the prescription medicines they need and hold PBMs accountable to the promises they’ve made.
PRESCRIBING THE PROBLEM
The true costs of medications are, for the most part, a mystery. Often, states that cover the cost of prescription drugs for state employees and Medicaid enrollees don’t know whether they are paying a fair price, local pharmacies face high costs to distribute prescriptions to patients, and patients know very little about why their out-of-pocket costs are so high.
Pharmacy benefit managers (PBMs) are large, billion-dollar companies that administer prescription drug benefits for health plans. PBMs set reimbursement rates paid to pharmacies for filling prescriptions and determine which drugs will be covered by insurance plans by creating lists called “formularies.”
After a pharmaceutical company sets the initial list price for a medicine, it negotiates with PBMs for placement on the PBMs’ formularies and PBMs negotiate savings or rebates on medicines. PBMs were meant to give patients and purchasers leverage when they negotiate prescription medicine prices. However, PBMs savings often aren’t passed on to patients, employee health plans, and the public insurance programs that pay the final price.
PBMs are not only keeping savings from patients, but also from pharmacists and state governments. PBM reimbursement practices have forced some local pharmacies out of business. At the same time, a growing number of states have found that they’ve been overcharged by PBMs to the tune of hundreds of millions of dollars.
Minnesota will capture historic prescription drug savings through a PBM reverse auction process. In essence, a well-designed PBM reverse auction creates a transparent marketplace for PBMs competing dynamically with one another on the basis of the cost of their bids over multiple bidding rounds to win a contract with the state. The PBM reverse auction has been described aptly as an “eBay for prescription drug pricing plans.”
There are many other policy solutions that could hold PBMs accountable to their promise to lower out-of-pocket costs. We will continue working together to identify the best solutions for all Minnesotans.
SOLUTIONS FOR MN
We’re working to identify ways to deliver PBM savings back to Minnesotans. One of the largest and most direct source of savings on state prescription drug spending without resorting to cost-shifting to public sector employees or cutting public employee benefits is to procure a pharmacy benefit manager (or “PBM”) through a dynamically-competitive PBM reverse auction. This reverse auction process also helps to hold the selected high-value PBM accountable to the state with ongoing, automated, validation of 100% of PBM claims.
Minnesota will captured historic prescription drug savings through this PBM reverse auction process, resulting in 27% savings for public sector budgets and taxpayers. In essence, this well-designed PBM reverse auction creates a transparent marketplace for PBMs competing dynamically with one another on the basis of the cost of their bids over multiple bidding rounds to win a contract with the state. The PBM reverse auction has been described aptly as an “eBay for prescription drug pricing plans.”