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December 2018

How Pharmacy Benefit Managers Add to Financial Toxicity: The Copay Accumulator Program

Author Affiliations
  • 1Cardinal Health Specialty Solutions, Cardinal Health, Dublin, Ohio
JAMA Oncol. 2018;4(12):1665-1666. doi:10.1001/jamaoncol.2018.4554

The sustained rise of prescription drug costs has continued to receive considerable attention, with recent blame being directed toward the pharmaceutical supply chain, sparking heated debate.1 The implication of the supply chain as a cause of drug price escalation warrants a historical perspective. Pharmaceutical products were initially reimbursed by insurers under major medical expenditures; lumped in with physician visits, laboratory work, imaging, and other health care costs. The 1980s, alongside the proliferation of computers, established online claims systems, formularies, and drug utilization reviews, all of which became industry standards. The Pharmacy Benefit Manager (PBM) industry grew out of a third-party business known as pharmacy claims processing; where drug cards were provided to manage a rudimentary formulary.

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