What is PBM ABUSE?

PBMs first emerged as a means to streamline the management of prescription drug benefits for health insurance plans. However, their extortion of the market and complete lack of transparency have led to real harm for patients, healthcare providers, and those who help pay for patients' healthcare (e.g., employers, Medicare, and Minnesota's Medicaid program). Their conduct has also led to the most expensive prescription drug market in the developed world—one in which Americans are rationing their prescriptions, taking on debt to afford treatments, or completely forgoing taking their lifesaving medication because it's simply unaffordable.

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"PBM abuse" is an umbrella that refers to the several abusive practices of PBMs, including but not limited to: inappropriately low or no reimbursement to pharmacies for services provided; the retroactive collection of DIR fees on Medicare claims ("clawbacks"); forcing pharmacies into abusive, one-sided contracts; "steering" patients to pharmacies they own and operate; and making patients take expensive brand name drugs when cheaper generic alternatives exist.