Center for Studying Health System Change
Finds That Insured Consumers with PBM Drug Coverage

Report Far Fewer Prescription Drug Access Problems

(Washington, DC)—A new survey out today finds that consumers with drug benefits provided through pharmacy benefit managers (PBMs) and private health insurance are far less likely to report having problems affording their prescription drugs as do consumers with drug coverage provided through public programs that generally don’t rely on PBMs, underscoring the need for policymakers to embrace PBM tools, the Pharmaceutical Care Management Association (PCMA) said today. PCMA is the national association representing America’s pharmacy benefit managers (PBMs). The survey, “An Update on Americans’ Access to Prescription Drugs,” was conducted by researchers at the Center for Studying Health System Change (HSC).

“All roads to expanded access and lower prescription drug costs lead to pharmacy benefit managers,” said PCMA President Mark Merritt in commenting on the new analysis. “PBM tools used in the private sector result in far fewer prescription-drug access problems for consumers than government regulatory approaches commonly used in programs like Medicaid. Policymakers should build on PBMs’ proven record of lowering costs and expanding access to prescription drugs.”

According to the HSC survey, chronically ill consumers without prescription drug coverage report far greater access problems than consumers with PBM-administered drug coverage. In 2003, about half of chronically ill, uninsured consumers went without at least one prescription drug, according to the survey. For working-age adults with public insurance—primarily Medicaid—one-third reported an access problem. In marked contrast, just 15 percent of the chronically ill consumers served by PBMs and private insurance reported access problems with prescription drugs.

On a positive note, chronically ill elderly Medicare beneficiaries with employer-sponsored retiree coverage reported fewer prescription drug access problems in 2003 than in 2001. A majority of employer-sponsored retiree drug coverage is administered by PBMs. PBMs are expected to play a central role in administering the Medicare part D prescription drug benefit beginning in 2006.

PBMs administer prescription drug plans for more than 200 million Americans with prescription drug coverage provided through the nation’s small and large employers, Taft-Hartley union plans, health insurers, state and federal-employee benefit plans, and Medicare Advantage health plans. PBMs help drive down the cost of prescription drugs for consumers and plan sponsors â?? on average by 25 percent â?? by negotiating discounts with drug manufacturers and retail pharmacies. These savings are, in turn, passed on to consumers. PBMs also provide consumers with important quality protections, such as disease management and physician and patient education. PricewaterhouseCoopers estimates that PBMs will save consumers and employers $1.3 trillion dollars on prescription drug costs over the next decade.
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The Pharmaceutical Care Management Association (PCMA) is the national trade association representing America’s pharmacy benefit managers (PBMs). PCMA member companies provide pharmaceutical care management services to more than 200 million Americans.

Contact Information:
Phil Blando
202-207-3614