AJMC View: PBM GER Fees Threaten Specialty Pharmacies

Many medically integrated specialty pharmacies (MIPs) take a hit when filling prescriptions due to PBM fees known as generic effective rate (GER). This can reduce patient access by disincentivizing the prescribing of these drugs. In a new AJMC View, authors Darrel L. Willyard, PharmD, and Alexis V. Fanshier, BA, explain how GERs impact specialty pharmacies and patient health outcomes.

According to the authors, “Pharmacy benefit managers (PBMs) began as intermediaries between insurers and providers. In recent years, mergers and acquisitions have led to PBMs being under the same roof with insurers, specialty pharmacies, and, in some cases, provider services. Three PBMs (Express Scripts, CVS Caremark, and OptumRX) control approximately 89% of the market. All 3 PBMs also own specialty pharmacies, making it lucrative for them to keep prescriptions within the pharmacies they control.”

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(Source: AJMC, December 20^th, 2022)