There’s an old adage that says, “you can’t squeeze blood out of a turnip.”
In 2026, lawmakers in Congress and the commonwealth put that theory to test and passed legislation to further regulate pharmacy benefit managers, or PBMs, in the name of lowering prescription drug costs.
But here’s the problem: when you look at the total dollar spend on a prescription drug, PBMs account for just 6 cents. Drug manufacturers take roughly 65 cents. Pharmacists account for about 25 cents. Wholesalers receive another 4 cents.
If the goal is truly to lower prescription drug costs for patients, families and employers, public policy cannot focus exclusively on one of the smallest slice of that pie while ignoring the largest.
Here’s another problem. PBMs actually reduce the amount Virginians pay for prescription drugs. This is why they exist.
Employers, governments and union health plans hire PBMs to help provide the families they cover with affordable access to prescription drugs. A core part of that, PBMs negotiate with drug companies and pharmacies to help make medication affordable.
Attacking PBMs will never lower drug prices because it’s going after the wrong part of the supply chain. Despite more than 25 laws regulating PBMs in Virginia since 2015, prescription drug costs have continued to rise. According to Freedom Virginia, a nonpartisan, nonprofit organization, the average per-person prescription spending in the commonwealth rose from $1,400 to $1,500 between 2015 and 2020, surpassing the national average by 36%.
Competition remains one of the most effective tools for lowering healthcare costs. PBMs are the only entity in the prescription drug supply chain whose primary role is to negotiate lower drug prices on behalf of employers, labor unions, government programs, and patients. Today, PBMs save more than $1,100 per person annually for the 289 million Americans whose prescription benefits they manage.
There are things Governor Spanberger and lawmakers can do to lower drug costs and improve access to care.
- They could put in place policy to encourage doctors to use electronic prescribing tools that show patients their lowest-cost drug options before they get to the pharmacy.
- Or increase transparency around prescription drug wholesalers, enormous companies that have huge power over generic drug prices but operate completely in the shadows.
- Or rein in direct-to-consumer pharmaceutical advertisements that drive needless demand for high-cost drugs and can mislead patients.
If policymakers are serious about affordability, they should examine every part of the prescription drug supply chain. But the quickest, clearest and most direct path to lower drug costs remains the same: pharmaceutical drug companies lowering the prices of the medicines they sell. PCMA stands ready to work with lawmakers on solutions that make prescription drugs more affordable for Virginia families.
David Marin is CEO of the Pharmaceutical Care Management Association.
