SHARx Calls for Accountability as Policymakers Target PBM Practices Nationwide
Rising drug costs and access barriers are prompting employers to examine the role of Pharmacy Benefit Managers (PBMs) in healthcare delivery. SHARx is highlighting how these intermediaries affect both spending and patient access to prescribed medications.
As lawmakers pursue measures to reduce prescription drug costs, employers across the United States are facing a pressing issue: they are funding a system that lacks transparency, control, and oversight, all while employees struggle to access the medications they require. Paul Pruitt, Chief Growth Officer and co-founder of SHARx, emphasized the need for clear accountability in healthcare. “Employers should know what they’re paying for, patients should get the medications they need without obstruction, and clinical decisions should stay where they belong, between doctors and patients,” he stated.
PBMs, which manage all prescription drug claims nationwide, have significant influence over pricing, coverage, and access decisions, often without providing adequate transparency to the employers financing these systems. According to SHARx, employers bear the burden of rising drug costs while PBMs control access through formularies, pharmacy networks, and utilization controls such as prior authorization and step therapy.
Recent policy initiatives aim to impose fiduciary responsibilities on PBMs, requiring them to act in the best interests of employers and patients rather than solely focusing on their financial gain. However, efforts to regulate PBM practices are facing legal hurdles that may hinder effective reform, leaving many systemic issues unresolved. Employees remain caught in the middle, often facing delays, denials, or high costs associated with necessary medications.
The current landscape has led employers to rethink their approach to prescription benefits as a procurement challenge rather than a traditional insurance issue. By seeking transparent pricing and better management strategies, employers aim to improve both cost control and patient access. “This is no longer an HR issue; it's a business risk issue,” Pruitt noted, underscoring the need for change in how pharmacy spend is managed and perceived.