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Even As PBMs Face Reckoning, Formulary Exclusions Rise Again In 2023

 
• By Leslie Small

Congressional scrutiny aside, ‘the rebate model remains alive and well’ as the big three pharmacy benefit managers exclude around 600 drugs each from their formularies.

PBM exclusions
There's nothing strange in the neighborhood pharmacy about growing PBM exclusions. • Source: Nielsen Hobbs; the Pink Sheet | Shutterstock images

With PBM execs slated to testify at a Senate hearing about drug costs on 10 May, scrutiny of pharmacy benefit managers seems be cemented as part of the drug pricing debate, thanks in large part to a successful campaign from their vendors/rivals, the pharmaceutical industry.

So one might imagine that having essentially lost the fight to set the terms of the debate, PBMs would...

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Eisai and Lilly explain why they disagree with today’s conclusion by the health technology assessment institute, NICE, that the benefits of their respective drugs for Alzheimer’s disease are too small to justify the additional cost to the National Health Service.