Robert Zirkelbach, Chief Public Affairs Officer and Head of Strategic Initiatives for the Pharmaceutical Research and Manufacturers of America (PhRMA), has emphasized that efforts to lower drug prices for U.S. patients should concentrate on addressing the roles of intermediaries and international contributions. Zirkelbach made this statement on the social media platform X.
"Lowering drug prices for U.S. patients starts by reining in middlemen and getting other countries to pay more to support the innovation they rely on, not by implementing Most Favored Nation policies," said Zirkelbach, Chief Public Affairs Officer & Head of Strategic Initiatives.
Pharmacy Benefit Managers (PBMs) serve as third-party administrators for prescription drug programs across various sectors, including health insurers, employers, and government agencies. They are responsible for negotiating discounts and rebates with drug manufacturers, managing pharmacy networks, processing claims, and providing additional services such as medication therapy management and mail-order pharmacy options.
According to a Federal Trade Commission (FTC) report, the "Big 3 PBMs"—Caremark Rx (CVS), Express Scripts (ESI), and OptumRx—have significantly marked up specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent. This practice generated over $7.3 billion in revenue from 2017 to 2022. The report identifies spread pricing as a major issue, where PBMs charge health plans more than they reimburse pharmacies.
The FTC report also indicates that rebate agreements between PBMs and drug manufacturers may lead to higher list prices for medications. Additionally, fees and reimbursement rates set by PBMs can jeopardize the financial stability of small pharmacies, potentially limiting patient access to essential medications and increasing out-of-pocket expenses.
Zirkelbach is responsible for overseeing media relations, communications, and advocacy efforts at PhRMA. His previous roles include serving as Global Head of Issues and Advocacy at ExxonMobil and acting as spokesman for America’s Health Insurance Plans during the Affordable Care Act debate. Earlier in his career, he worked as press secretary for Congressman Jim Nussle.
