White Paper: Addressing Barriers to Pharmacy Profitability: Challenges of Pharmacy Benefit Managers and Beyond

“Parasitic traffic cops,” was the description used by National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey to describe the negative impact pharmacy benefit managers (PBMs) have on the nation’s prescription drug processes and pharmacy probability. Hoey added to his blistering assessment by comparing them to “uninvited guests who won’t leave,” who embed themselves “into the flow of every prescription drug transaction from the pharmaceutical manufacturers’ corporate headquarters to the consumers’ kitchen table….” 

PBMs have been around since the late-1960s, when they first emerged as a way to facilitate claims processing by insurance companies.  Prior to that, according to The Pulse podcast, patients were responsible for mailing prescription claims to their insurance companies, and then waiting for reimbursement.  “With PBMS,” the report noted, “the process was streamlined and digitized, easing the burden on insurance companies, and becoming an important link between pharmacies and health plans.” Read More >