8/21/2025
The Problem with PBM Practices
PBMs aren’t pharmacies. They don’t manufacture drugs. They’re middlemen who profit from the complexity and lack of transparency in our healthcare system. This can lead to:
- Higher out-of-pocket costs for patients
- Limited access to certain medications
- Confusion about why some prescriptions are covered and others aren’t
How to Protect Yourself as a Consumer
- Ask About Lower-Cost Alternatives – Sometimes the cash price is cheaper than your copay.
- Check Your Plan’s Formulary – Know in advance what’s covered.
- Use Price Comparison Tools – Websites and apps like GoodRx can help you find the best price.
- Talk to Your Doctor – If a medication isn’t covered, your provider may be able to request an exception or prescribe a covered alternative.
Final Thought: PBMs may be hidden from view, but their decisions affect your wallet and your health. Understanding their role — and asking the right questions — can help you take back control.
Want a plan that gives you more pharmacy freedom? Call (716) 503-1113 for a free consultation.