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Innovation and Competition Bring Down Costs


The news that the Food and Drug Administration (FDA) recently approved Aduhelm to treat Alzheimer’s disease has been met with hope, but also skepticism in terms of the drug’s clinical safety and efficacy, and its cost. Here’s a different perspective — a “forest through the trees” view — from America’s pharmacy benefit managers, PBMs, which are positioned squarely at the intersection of access and affordability for patients.

The inspiration borne of innovation is not lost on PBMs. Breakthrough treatments that give patients hope and higher-quality lives are always welcomed. The job of PBMs — on behalf of employers, unions, and government programs providing health care coverage to patients — is to enable access to innovations while balancing the safety, efficacy, and clinical appropriateness with the cost and value they provide. The approval — and price point — of Aduhelm is not the health care industry’s first experience with a medication perceived to be a financial back-breaker. The speculation of the budget-busting costs swirling around the introduction of a Hepatitis C cure, Sovaldi, and the PCSK-9 cholesterol-lowering drugs was largely unrealized because providers, physicians, and PBMs worked to strike the balance between cost and access for patients.

PBMs are recognized for leveraging market competition to negotiate discounts and rebates on prescription drugs. Our companies also negotiate value- and outcomes-based contracts for drugs that have quantifiable outcomes. Because the use of prescription drugs can lead to avoidance of more expensive procedures, paying for a positive outcome makes sense, and it is these common-sense cost measures that are the focus of much of our work and which are already being explored in the case of Aduhelm. These arrangements are a key element of our three-part plan for addressing high drug costs. 

Read more about Aduhelm and how PBMs are always #OnYourRxSide on PCMA’s President & CEO, JC Scott’s Medium page.

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Pharmacy benefit managers (PBMs) are your advocates in the health care system, working to lower out-of-control prescription drug costs for patients across the country.

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