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CAPD: Consumers are Facing Higher Out-of-Pocket Costs Because Drug Prices Are Rising


Washington, D.C. –The Coalition for Affordable Prescription Drugs (CAPD) today commented on a report issued by the pharmaceutical industry.

“Consumers are facing higher out-of-pocket drug costs because drug prices continue to rise; it’s as simple as that,” said Meghan Scott, Executive Director of CAPD.

“In 2015, the average list price for drugs increased by 12.2 percent while PBM-negotiated net prices were held to under three percent. That difference between list prices and net prices represents real savings for employers and consumers.

“Our coalition partners are committed to finding new ways to leverage private sector solutions already at work in the system to help all consumers, including those with high-deductible health plans, get access to the medicines they need at a price they can afford. Employers, unions and health plans across the country have found partnering with pharmacy benefit managers (PBMs) to be the most effective way to manage rising drug costs. These partnerships take on even greater importance as drug prices continue to rise.”

PBMs also work with partners whose employees or members are enrolled in high-deductible health plans to ensure they can get medicines they need at the lowest cost possible. To do so, PBMs may offer a preventive medication list, which allow for coverage of certain medications (e.g. –those that treat chronic conditions such as hypertension or high cholesterol) at little or no cost to the patient. A PBM and a partner may also structure a plan so that discounts can be given at the point of sale to members with high-deductible health plans.

CAPD launched earlier this year to add the perspective of the employers, unions, health care systems and many others who choose to partner with pharmacy benefit managers (PBMs) to the debate surrounding the rising cost of prescription drugs. These partnerships represent private sector solutions that deliver value to the health care system, provide sustainable access to affordable, effective prescription drugs and support patient-focused clinical programs that lead to better health outcomes for workers and employees.