My Prescription Costs What?

This WSJ story highlights the challenges faced by patients as they navigate the "convoluted" ways in which drug prices are set between manufacturers and the pharmacy benefit managers (PBMs) who negotiate on behalf of health insurance plans.

As featured in the WSJ story, patients can find two dramatically different prices for the same drug – one price using their insurance benefits, and another by paying cash out of pocket. These types of "funky" results arising from the complexities of the US healthcare payer system are also gaining the attention of legislators, policy organizations -- and antitrust enforcers. In June 2022, the FTC launched a market study of PBMs and the impact of their practices on pharmacies, payers, doctors, and patients.