The PBM Problem: When Profit Gets in the Way of Cancer Care
Behind every cancer patient fighting for their life, there’s another battle being fought, one they never signed up for. It’s not with their doctor, their hospital, or even their insurance company. It’s with a faceless middleman called a Pharmacy Benefit Manager, or PBM.
PBMs are the “invisible hands” that decide where you can fill your prescription, how much you pay, how much the pharmacy gets paid, and whether your medication arrives at all. They claim to “save employers money” and “manage drug costs.” But the truth is far more sinister, especially for Arkansas cancer patients who depend on timely, local, coordinated care.
These companies were supposed to make drugs more affordable. Instead, they’ve quietly built an empire of control and confusion, where the sick pay more, the employers pay more, the doctors have less power, and the PBMs get richer.
The Employer’s Mirage: Fake Savings, Real Losses
On paper, PBMs promise savings. In reality, they have created one of the most expensive shell games in healthcare.
1. They pay themselves first.
PBMs reimburse their own “affiliate” pharmacies, the ones they secretly own, at much higher rates than local, independent pharmacies. Study after study at the federal and state level shows the same pattern: PBMs inflate the cost of medicine when they control both sides of the transaction. What looks like a discount is really a markup in disguise.
2. They brag about rebates, but it’s your money going in circles.
PBMs love to show employers and plan sponsors big rebate checks. What they don’t tell you is that these rebates are funded by inflated drug prices in the first place. The higher the drug cost, the bigger the rebate, and the more “savings” the PBM can claim, even though the total cost to the plan keeps skyrocketing. It’s a con that’s fooled too many employers into celebrating “savings” while their employees’ premiums and deductibles climb higher every year.
3. They waste money on drugs that get thrown away.
Cancer treatments change constantly. Doses are adjusted, regimens are stopped early due to side effects, or new therapies are started midstream. But PBM-owned mail-order affiliate pharmacies don’t care. Their only incentive is to keep shipping and billing. Every time a patient’s medication changes, the old bottles, often worth thousands of dollars, go straight into the trash. Employers and taxpayers foot the bill for drugs nobody uses.
4. They increase the total cost of care.
By disrupting integrated care, PBMs cause cascading harm across the entire system. When patients do not receive their medications on time, or at all, they often end up in the emergency room or are admitted to the hospital with worsening conditions.
What PBMs fail to understand is that a cancer patient is not just on one or two drugs. They are on dozens of concurrent medications that must be carefully timed before and after treatment. These medications must be managed in coordination with the oncology team (medical oncologists, radiation oncologists, surgical oncologists, etc.), monitored for interactions, and adjusted based on bloodwork and side effects. Expecting patients to fill some medications elsewhere, without this coordination, is medically inappropriate.
There is no medical or ethical basis for breaking apart cancer therapy. It disregards the patient’s medical needs, their physical limitations, and their right to be treated as a person fighting for their life, not as a line item on a spreadsheet. The result is predictable: more emergency visits, more hospitalizations, more side effects, and higher costs for both the plan and the patient.
How PBMs Hurt Cancer Patients
For cancer patients, time is everything. Yet PBMs routinely delay, disrupt, or deny the medications that keep people alive.
1. They break up coordinated cancer care.
PBMs force patients to hunt down their medications through mail-order systems that are anything but convenient. Imagine being nauseous, exhausted, and trying to manage multiple prescriptions while the PBM tells you your local oncology pharmacy, the one inside your doctor’s clinic, isn’t “approved” or “authorized” to dispense the medication that you need.
2. They cause dangerous treatment delays.
Patients often wait weeks for lifesaving medication. Several documented Arkansas patients even progressed to a higher cancer stage because their PBM-controlled pharmacy took over 30 days to deliver the drug their doctor prescribed (they simply forgot). That’s not cost savings, that’s cruelty. These PBMs and affiliate pharmacies didn’t catch the omission until the provider intervened after learning that their patient has been medication-less for a month! At the same time, they sell services that tout medication adherence and medication reconciliation to employers – for an additional fee.
3. They keep filling drugs doctors have stopped.
When a regimen changes, PBMs don’t stop billing. They keep mailing medications patients no longer need, costing government programs and employers millions in wasted drugs that end up being destroyed by clinics.
4. They ignore patients’ preferences.
Even when patients beg to pick up their medications locally, where they can ask questions and get immediate help, PBMs block them.
5. They disrupt integrated care.
Cancer care works best when doctors, pharmacists, and nurses work together. PBMs tear that apart. They require “prior authorizations”, “step therapy” (making patients fail on cheaper drugs first), steer patients to their affiliate mail-order pharmacies, and ignore the total cost of care, which includes infusion, injections, and supportive medications.
6. They harass patients.
PBM affiliate mail-order companies are notorious for calling patients relentlessly, pressuring them to refill prescriptions even when they’ve said no. Some even call patients’ family members trying to push a fill at their affiliate pharmacy (a sale to them).
7. They undermine doctors.
PBMs have gone so far as to reduce prescribed doses or override oncology orders, telling patients they “don’t need as much” medication. These aren’t doctors. They’re corporate clerks in cubicles making life-and-death decisions for patients they’ll never meet.
8. They operate the lowest-rated affiliate pharmacies in America.
Don’t take our word for it. Go look. PBM-owned mail-order pharmacies have thousands of one-star reviews from real patients, not anonymous ones, begging to escape being forced to use them. Patients describe lost shipments, wrong doses, unreturned calls, and a total lack of compassion in their heart-felt comments.
The Bottom Line
PBMs have turned cancer care, one of the most personal, human, and urgent areas of medicine, into a spreadsheet exercise driven by greed. They’ve convinced employers they’re saving money while quietly draining billions from the system and forcing patients to suffer.
By cutting off local care, delaying vital treatments, and creating waste at every step, PBMs are not reducing costs, they are multiplying them. Every disrupted prescription, every missed dose, and every unnecessary ER visit adds up to one thing: higher total healthcare costs for the plan and worse outcomes for the patient.
For Arkansas employers, families, plan sponsors, and policymakers, the message is simple: stop letting middlemen decide how your employees and plan members get their medicine.
Ask where your pharmacy dollars are really going. Ask how much your PBM’s own pharmacies are being paid. And most importantly, ask your local providers what they’ve seen firsthand, because they’re the ones cleaning up the mess PBMs leave behind.
What You Can Do
Enough is enough. If you’re an Arkansas employer, plan sponsor, or patient, it’s time to demand accountability.
- Call your representatives at both the state and federal level and tell them to investigate and rein in PBMs’ abusive practices.
- Contact your HR department or benefits manager and demand transparency on how your PBM handles pricing, rebates, and pharmacy networks. Show them the medications that you continue to receive that is wasting critical funds.
- Reach out to the Arkansas Insurance Department for group and exchange plans and ask for a full audit of PBM contracts and self-serving arrangements.
- Let the appropriate plan sponsors and regulatory authorities know when your information is being misused, you are being harassed, or your treatment is being delayed or going against the medical regimen outlined by your provider.
The people paying for these plans, the employers, the taxpayers, and the patients, deserve to know the truth. The only way things change is if we all push back together.
PBMs may be powerful, but they’re not untouchable.
It’s time to put patients back where they belong: first.