Lawmakers Hear Competing Views on PBMs’ Role in Drug Prices and Formularies

CHARLESTON, S.C. — Lawmakers probing the state’s prescription‑drug system on Tuesday heard sharply differing accounts of how pharmacy benefit managers, or PBMs, affect prices, patient access and where prescriptions are filled.

The ad hoc committee convened by Rep. Heath Sessions (chair of the House medical subcommittee) heard PBM and insurer representatives argue PBMs reduce overall plan costs through negotiations, formulary design and clinical programs. Manufacturers and independent pharmacists countered that rebates, opaque fees and vertical integration have created misaligned incentives that can raise out‑of‑pocket costs, steer patients toward PBM‑owned pharmacies and squeeze local drugstores.

Why it matters: PBMs sit at multiple points in the drug supply chain — negotiating discounts with manufacturers, designing formularies and reimbursing pharmacies — giving them outsized influence over which medicines patients can access and how much consumers and plan sponsors ultimately pay. Lawmakers said they called the hearing to understand how that influence affects state purchasers (including Medicaid and the state employee plan) and South Carolina residents.

Most of the panelists outlined a complex flow of money and services. Michael Powell of the Pharmaceutical Care…