PhRMA has launched another attack on pharmacy benefit managers (PBMs). In a new video ad, the Big Pharma trade group accuses the middlemen of deciding which medicines patients can get based on how much money they make on each sale.
The TV spot, PhRMA’s first anti-PBM attack ad since Congress passed pricing legislation, shows a pharmacist apologizing to a patient that “this medicine isn’t covered by your insurance.” As the pharmacist goes to hand the script back to the patient, a man in a blue suit swoops in, grabs the piece of paper, chuckles and starts to explain how the system works.
“I decide which medicines you can get,” the man says. When challenged by the patient, who tries to take the script back and says “you’re not my doctor,” the man, smiling throughout, keeps hold of the paper and replies, “that’s right, I’m your insurance company’s pharmacy benefit manager, or PBM, and I don’t make as much money off this one.”
The final section of the ad features a statistic from a PhRMA-funded assessment (PDF) that found the three largest PBMs—CVS Caremark, Express Scripts and OptumRx—denied coverage to more than 1,150 medicines in 2022. At the very end, the man, now standing alone in front of white backdrop, flexes and drops the script and walks off. The final message: No one should stand between you and your medicine.
PhRMA ran similar attack ads in 2019 and 2021, using the same man in the blue suit to argue that PBMs get discounts on medicines that aren’t passed on to seniors and that 46% of spending on prescription drugs goes to middlemen. The 2021 ad ended with a call to action about telling Congress to “fix drug pricing legislation so that middlemen share the savings with patients.”
The new video, which is part of a broader campaign featuring TV, radio, print and digital ads, launches into a pricing environment reshaped by the passage of the Inflation Reduction Act (IRA). While working to shape the implementation of the IRA, PhRMA is simultaneously calling for lawmakers to pass reforms to hold PBMs accountable and reduce costs for patients.
PhRMA’s push for PBM reform could put it on the same side as an unlikely ally: Sen. Bernie Sanders, I-Vermont. Sanders recently introduced the Pharmacy Benefit Manager Reform Act in a bid to increase oversight of PBMs. The bill is the culmination of mounting pressure on PBMs that has seen lawmakers question why the organizations “even exist.”
The Pharmaceutical Care Management Association, a PBM industry association, ran its own ad earlier this year to defend the practices of its members, arguing that they “secure savings and support a more affordable future for patients, pushing big drug companies for price concessions that help lower costs by more than $1,000 per person each year.”