Pharmacy benefit managers deliver on their mission every day to expand access to prescription drugs, saving Americans on average $1,040 per person annually. 

Last month, three leading pharmacy benefit companies pledged to Sen. Bernie Sanders, the chairman of the Senate Committee on Health, Education, Labor and Pensions —  ahead of a recent congressional hearing where major drug manufacturer Novo Nordisk testified on how the company chooses to price popular GLP-1 drugs — that they are committed to facilitating access to these drugs, should Novo Nordisk (and other GLP-1 drug manufacturers) decide to lower the price of certain GLP-1s to $100 or less per patient per month for health plan sponsors.

In fact, PBMs are already working to negotiate lower costs for GLP-1s. Still, more meaningful progress for all patients cannot happen without drug companies first lowering their list prices.

Here’s the thing. This commitment from PBMs is not something new. This is how our companies work. Once a drug company sets a list price, PBMs negotiate with the drug company to get the net cost — the amount employers and plan sponsors pay for prescription drugs that they cover for the people on their health plans — as low as possible. Meanwhile, the drug companies’ list price decisions are based on their profit incentives, spending needs, and other factors under their control.

Big drug companies must put patients over profits and substantially lower the price as a starting point for negotiations with PBMs to ensure access and affordability for health plan sponsors and the individuals and families who rely on them for health insurance. In other words, if a drug company doesn’t also address the drug’s net price, there will be little progress. Big Pharma needs to do better than that.

This latest exchange is a clear example of how drug companies use PBMs as their scapegoat for why they “can’t” lower the list prices of prescription drugs. This is factually inaccurate. Countless analyses, including analysis using Centers for Medicare and Medicaid Services data of the top 250 brand-name drugs in Medicare Part D, confirm that price increases from big drug companies are unrelated to PBM negotiations. In fact, other studies have found that prescription drugs with the largest list price increases do not have rebates.

By deflecting from their anti-competitive practices, like misusing the patent system to keep more affordable alternatives from coming to market, drug companies can charge whatever price they want on their products. When they lower the cost of their drugs — like some big drug companies did last year on high-priced insulin products — the PBM industry welcomed it … and then did its part to further expand access for diabetes patients in need of these products. 

A little-known fact is that even before this move by insulin manufacturers — and even before the implementation of the Inflation Reduction Act last year — PBMs had already leveraged competition and implemented special programs that decreased the out-of-pocket costs for insulin products.

When one drug manufacturer lowers its prices, it must still compete with other GLP-1 manufacturers for formulary placements — competition is a good thing and applies downward pressure on drug companies to lower their prices to secure formulary placements.

Meanwhile, PBMs are using their specialized pharmacy benefit expertise to actively support employers that cover GLP-1s for people seeking to lose weight. While the coverage decision belongs to the employer and plan sponsor, PBMs of all shapes and sizes (and there are 70 PBMs competing for employers’ business in this country) are offering them comprehensive programs to help the right patients gain access to these treatments, combined with services that will help maximize the chances of long-term treatment success.

Bottom line: To deliver lower prescription drug costs for patients, drug companies need to do their part and lower the list prices of the drugs they make. That has to be the first step. We applaud Sanders for recognizing that. Our industry stands ready to continue our work to negotiate for lower costs and greater access. The question for drug companies is: Will you do your part and answer the call to lower list prices as a starting point for negotiation?