Why are drug prices so random? Meet Mr. PBM


I filled a prescription recently, and the drugstore said they wanted more than 700 bucks… for an old-line generic drug. My insurance ended up knocking that down, but it was WEIRD.  And it meant a big homework assignment for me.

Oh no! Now I have to learn how prescription drug pricing works.

Luckily, I got help. Both from some experts, and from the classic Christmas movie It’s a Wonderful Life (source of the pictures above and below, of course).

I totally cracked it, man!

I mean, what I actually learned was not a hundred percent cheerful.

We get these unpredictable prices thanks to companies that — surprise! — make a big profit from driving prices up.  (They’re called “pharmacy benefit managers” — PBM for short.)

Theoretically, they work for insurance companies and employers who pay the premiums, and they’re supposed to keep drug prices down.

Economist Geoffrey Joyce used to think they did OK at that, but he’s changed his mind.

One thing that turned him around:

They got sued in several states, saying, ‘Hey, you should be acting in the best interest of your clients.’ And they’ve won in court saying, ‘No, we have no obligation to do what’s best for our clients. We do what’s best for us.’

So, not all sunshine. 

But: Feeling a little smarter about the whole thing? It’s a victory. Also kinda fun.