Report: Oregon Pharmacy Benefit Managers pass on less than 1% of drug rebates to enrollees

PORTLAND, Ore. ( KOIN ) — Newly-uncovered data shows Oregonians benefitted from less than 1% of the drug rebates Pharmacy Benefit Managers collected in 2023.

PBMs serve as intermediaries between medication manufacturers and consumers, determining which drugs are covered by health insurance and where prescriptions can be filled. With the passage of Senate Bill 192 , these third-party entities are now required to self-report the “aggregated amount of rebates, fees, price protection payments, and any other payments” manufacturers send.

According to the data published by the Oregon Department of Financial Regulation , 18 PBMs received $287,583,732.64 in rebates and payments from manufacturers last year.

A majority of the payments, $283,727,097.34, went to insurance companies — while $2,236,217.76 were passed on to consumers. The managers retained the remaining funds as revenue.

However, Oregon State Pharmacy Association Executive Director Brian Mayo is suspicious of the self-reported data.

“It is laughable we would take [PBMs] own word for it,” Mayo wrote in an email. “Are we expected to believe that a PBM, regularly posting $1.3+ Billion in quarterly, is passing through all but less than 1% of their profit back to patients? Patients at Oregon’s pharmacy windows would be taken aback by this insult to their intelligence.”

The executive director added patients have experienced an uptick in drug costs and a decline in access to local pharmacies. The House Committee on Oversight and Accountability noted similar points this July, when they revealed a report on the nation’s three largest PBMs that have been accused of hindering consumers and pharmacies with “deliberate, anticompetitive policies.”

Additionally, an audit the Oregon Secretary of State’s office released in August 2023 — before SB 192 went into effect — determined health officials weren’t ensuring “sufficient transparency and compliance” from PBMs.

According to Mayo, the findings from state and national officials show “PBMs are siphoning off profits and protecting their assets in tax-free, off-shore accounts, jeopardizing patient care and patient safety without regard.”

The recent data does not include payment details for public insurance programs like Medicare or the Oregon Health Plan.

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