Opinion: Connecticut must tackle PBM problem tolower health care costs for patients
by The Rev. Alexander R. Garbera
May 22, 2025
Every year, the cost of health care in Connecticut climbs. Patients continue to see health insurance premiums rise, but coverage doesn’t improve. Instead, people are stuck with sky-high copays, deductibles, and out-of-pocket costs for medically necessary prescription medications.
It was once a rarity that access to medications was delayed by requiring prior authorizations. Now this regularly adds further burdens to strapped medical providers and anxiety for patients, who wonder if they will be able to get medications they desperately need.
Many people settle for high-deductible plans to make insurance affordable; however, they still face high costs at the pharmacy counter. Regardless of coverage type, high co-pays for medicine have negative impacts and may deter patients from seeking care and treatment. This is bad for the patient, and if that medicine is being used to treat transmittable diseases, it is very bad for public health. Needless to say, these barriers are most sorely felt by the elderly, disabled, working poor, and those living with chronic health conditions.
This system is not working, and as a patient and Connecticut patient health care advocate, it’s clear to me that something needs to change. Legislators have an opportunity to do that by supporting HB 7192.
The question is: what’s really driving up the costs, especially when it comes to prescription drugs?
The answer is Pharmacy Benefit Managers (PBMs). These faceless middlemen manage the lists of covered medicines for public and private health insurers. They work for the insurance industry. PBMs were originally supposed to help lower drug prices. Still, over time, they have become profit-driven giants that seem less interested in helping patients and more about making access more difficult to secure better profit margins. These companies negotiate drug prices with manufacturers and decide which medications are covered by insurance, which often is not in the patient's best interest. PBMs keep hidden all the discounts and rebates they negotiate so patients do not see any of those savings. Instead, they end up paying far more than the actual cost of the needed medications.
The consequences of PBM practices are staggering. Studies have shown that in some cases, insurers and PBMs have charged as much as 27 times the price that drug manufacturers charge for medications. This is not just a problem in Connecticut but part of a larger national issue. Three major PBMs, owned by large insurance companies, now control 80% of the prescription drug market in the United States. In 2023, these companies raked in nearly $925 billion in revenue. Meanwhile, patients are stuck paying large pharmacy bills.
PBMs are not only hurting the patients but also devastating independent pharmacies. Independent pharmacists are often forced to fill prescriptions at a loss, reimbursed at rates that don’t even cover the cost of the drugs. It’s a practice that forces pharmacies to subsidize massive corporate profits, putting them out of business and making it harder for patients to access the medications they need. Independent pharmacies are particularly vital in underserved communities, where they often serve as a crucial point of care. If these pharmacies continue to close, it will only deepen the health care access crisis in our state.
Ultimately, it’s Connecticut taxpayers who are left paying the bill for the PBMs. The funds that could be used to lower drug prices or improve health care access are instead being funneled into the pockets of middlemen. Discounts that should be passed on to the patients are hidden away, leaving us with no choice but to accept higher premiums, higher deductibles, and ever-increasing prescription costs. This is unhealthy, if not deadly, for patients, public health programs, and public health. There needs to be transparency in these decisions.
Sustainable solutions aren’t as simple as limiting prices at the pharmacy counter. To address a disease, one must look at the root causes. Saying that a medication is affordable only is true to those who can afford it. Some solutions, such as Prescription Drug Advisory Boards (PDABs) and other price-setting proposals, only increase PBM profits while patients suffer. If Connecticut lawmakers are serious about making health care more affordable, they need to take action to change the way PBMs operate.
Legislation that requires transparency and accountability from PBMs would go a long way toward bringing down prescription costs and making the system work for patients, not just the middlemen. That’s why we are asking legislators to vote in favor of HB 7192 which would do just that.
The time to act in Connecticut is now. We need a health care system that prioritizes patients over profits.
The Rev. Alexander R. Garbera is a Connecticut patient advocate
