Challenges with the Pharmacy Benefit Management System and Patient Care

The Pharmacy Benefit Management system poses significant challenges to patient care. The system can make errors in drug coverage, delaying payments to pharmacies, putting financial strain on them. Pharmacy Benefit Managers have significant leverage in negotiations, owning mail-order pharmacies and using tactics to withhold payments for various reasons. These actions put small pharmacies out of business and consolidate power in larger pharmacy entities. Patients also face issues with drug pricing, where insurance companies negotiate rebates that lead to increased insurance costs for employers. The profit-focused nature of the system prioritizes financial gains over patient outcomes, contributing to the lack of awareness and understanding among the general population. Thus, the existing system lacks incentives for improvement, leading to unregulated issues affecting patient care.