In the case of some generic specialty drugs, PBMs may increase the price > 1000%. I deal with this daily. Costplus drugs (or almost as good GoodRx) will sell generic Aubagio (teriflunomide) for $10/month and generic Tecfidera (dimethyl fumarate) for $30/month with the insurer out of the loop. For some of my patients their required PBM tells the patients these meds are $1000 or more a month and then they are responsible for their copay (say 20% or $200 for patient and $800 by the insurer - at least before kickbacks).
One of the first question I ask my patients on these drugs is how much are YOU paying out of pocket. Every switch away from a PBM to Costplus makes me smile
PBMs have less leeway for branded products - and they profit more on specialty generics. They are less perverse for common generics but still charge the patient copay plus insurer combo more than a cash price price would be. Patient ends up paying little though for these cheaper drugs.
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