General Discussion

Introduction

Despite strong clinical evidence supporting the use of statins to reduce cardiovascular events, a substantial percentage of patients with elevated low-density lipoprotein cholesterol (LDL-C) are not being prescribed these life-saving medications. Pharmacists, as accessible healthcare providers and medication experts, have an important role in identifying gaps in care and optimizing lipid management.

The Scope of the Problem

Recent data from large observational studies and registries reveal that a significant number of patients who meet guideline-based indications for statin therapy remain untreated. A 2020 analysis of the National Health and Nutrition Examination Survey (NHANES) found that only 49.5% of U.S. adults eligible for statins under the 2018 American College of Cardiology/American Heart Association (ACC/AHA) guidelines were actually taking them (Salami et al., 2020).

Further, a study published in JAMA Cardiology demonstrated that even among high-risk populations, such as patients with established atherosclerotic cardiovascular disease (ASCVD), about one-third were not receiving statins, and…

Why PBMs Should Not Be Allowed to Operate Pharmacies: A Call for Fairness and Transparency

The pharmacy landscape has changed dramatically over the past two decades, with Pharmacy Benefit Managers (PBMs) playing an increasingly dominant role in determining medication access, cost, and reimbursement. While PBMs were originally designed to negotiate drug prices and manage formularies on behalf of insurers, many now own or are affiliated with their own mail-order and specialty pharmacies, raising major concerns about conflicts of interest, anticompetitive practices, and harm to patient care.

For pharmacists on the front lines, this vertical integration is not just a policy issue—it’s an urgent threat to the integrity of our profession and the accessibility of community-based care.

What Are PBMs and What Do They Do?

PBMs serve as middlemen between insurers, drug manufacturers, and pharmacies. Their roles include:

• Creating and managing drug formularies

Pharmaceutical Pricing Disparities: Why Drug Companies Sell Medications for Less Outside the U.S.

Introduction

Pharmaceutical pricing is a highly debated issue, especially in the United States, where prescription drug costs are significantly higher compared to other countries. Many Americans wonder why the same medications are sold for substantially lower prices abroad. This article explores the factors contributing to these pricing disparities, the role of pharmaceutical companies, and the implications for healthcare providers, including pharmacists.

The Global Pricing Discrepancy

The price of prescription drugs varies widely across different countries. For example, a study published in JAMA Internal Medicine found that insulin, a life-saving medication for diabetics, costs nearly ten times more in the U.S. than in Canada and other high-income nations (Luo, G., & Kesselheim, A. S., 2020). Similarly, cancer drugs and biologics are often priced lower in Europe and other developed nations.

Factors Influencing Drug Pricing Differences