AffirmedRx’s Efforts to Address PBM Transparency and Drive Industry Change

Greg Baker, CEO of AffirmedRx, shared with MHE editors how the company is addressing ongoing challenges in the pharmacy benefit management (PBM) industry, particularly corporate consolidation and transparency issues.

Baker noted the difficulty of resolving these problems solely through legislation due to loopholes and challenges in large, integrated companies.

“It’s going to be really hard to legislate our way out of it without having that law of unintended consequences,” he said.

AffirmedRx has been engaging policymakers, with Baker and his team making over 60 trips in the last two years to Washington, D.C., to educate federal agencies about PBM practices.

He highlighted that competition is also difficult because larger PBMs often keep savings for themselves instead of providing them to clients, which inflates profits instead of reducing costs.

Litigation could drive the most change, he suggested, as high-profile lawsuits, such as those involving Johnson & Johnson and Wells Fargo, are capturing employers' and benefit leaders' attention, which potentially sparks a shift toward better practices.