1. Put An End to PBMs! Tiffany Jew PharmD, MBA Candidate 2007 University of Southern California Pro Pharma Pharmaceutical Consultants, Inc

2. PBMs Profit While We Lose Employers contract with PBMs to: Coordinate their prescription drug plan To negotiate rebates and discounts on their behalf BUT PBMs dont act in the best interest of: Their clients The patients or plan holders The health care system

3. Swindling Their Clients PBMs are not acting in the clients best interest: Not always passing on rebates and discounts to their clients –Rebates/discount contracts kept secret from the client May be fraudulently inflating generic drug prices –Calculating prices differently to generate the greatest spread to their benefit

4. Garis, R. et al. Americas Pharmacist. Nov 2004.

5. Cheating Patients In order to profit from rebates, PBMs have… Pressured MDs to prescribe or change to brand name medications unnecessarily Coerced patients to use their own mail-order pharmacies where valid prescriptions were changed to higher costing brand Caused patients to pay higher co-pays

6. Bad for the Health Care System Inflated drug prices worsen the health care crisis Put community pharmacies out of business Not passing on savings that could relieve some of the cost pressures of employer benefits Expected to cost tax-payers $14.5 billion over 10yrs 1 –PBMs mail-order pharmacies will increase Medicare drug benefit costs –PBMs are allowed to both administer the benefit and sell the drug through their mail-order pharmacies 1. www.pharmacychoices.org

7. Garis, R. et al. Americas Pharmacist. Nov 2004. Mail Order Costs More $$$

8. Just Some That Have Sued PBMs 20 state attorneys general – Arizona, California, Connecticut, Delaware, Florida, Illinois, Iowa, Louisiana, Maine, Maryland, Massachusetts, Nevada, New York, North Carolina, Oregon, Pennsylvania, Texas, Vermont, Virginia, and Washington The State of Florida American Federation of State, County & Municipal Employees National Community Pharmacists Association and the Pharmacy Freedom Fund Peabody Energy Corporation Northwest Airlines Health Plans United States Attorney, Eastern District, Pennsylvania The State Teachers Retirement System of Ohio Chicago District Council of Carpenters Welfare Plan

9. Conclusion Recommendations: More regulation of their business practices More transparency so that rebates and discounts appropriately allocated to their clients Eliminate conflict of interest mail-order pharmacies

10. Rebuttal…