An Ethical Analysis of Pharmacy Benefit Manager (PBM) Practices

Area of Science:

• Health Economics
• Bioethics
• Pharmaceutical Policy

Background:

• Rising pharmaceutical costs and stakeholder impact necessitate evaluation of market practices.
• Pharmacy benefit managers (PBMs) are key players in the U.S. pharmaceutical market, facing increased scrutiny.
• Controversial PBM practices include formulary incentives and restrictions on disclosing lower-cost alternatives.

Purpose of the Study:

• To ethically analyze specific pharmacy benefit manager (PBM) practices using multiple decision-making models.
• To determine the ethical nature of PBM organizational practices impacting healthcare delivery.
• To provide an ethical framework for understanding current healthcare dilemmas involving PBMs.

Main Methods:

• Systematic application of multiple ethical decision-making models to PBM practices.
• Analysis of PBM-related dilemmas within the pharmaceutical environment.
• Incorporation of provider codes of ethics for comparative ethical assessment.

Main Results:

• Ethical assessment yielded mixed outcomes, with practices varying in ethicality based on the model used.
• Point-of-sale rebates were consistently deemed ethical.
• Market consolidation, gag clauses, and fluctuating pharmacy reimbursements were predominantly deemed unethical.

Conclusions:

• Ethical decision-making models offer a unique perspective on PBM practices and healthcare dilemmas.
• Some PBM practices are predominantly ethical or unethical, despite variations across ethical frameworks.
• Applying ethics-based frameworks is crucial for addressing complexities and stakeholder values in healthcare.