Iowa Ideas Conference: Spotlight on Prescription Drug Costs and PBM Reform

Last week, The Gazette’s Iowa Ideas Conference brought together policymakers, healthcare professionals, and advocates from across the state to tackle some of Iowa’s most pressing challenges, including rising prescription drug costs and the opaque world of pharmacy benefit managers (PBMs).

During the conference, the Gazette’s executive editor Zack Kucharski moderated a diverse panel, entitled, “Health Care, Cost of Prescription Drugs and Pricing Transparency” featuring Wes Pilkington, owner-pharmacist and president of the Iowa Pharmacy Association; Julie Urmie, associate professor at the University of Iowa College of Pharmacy; and Mark Blum, managing director of the PBM Accountability Project.

Blum outlined how PBMs were originally created to help consumers access affordable medicines but have since evolved into powerful middlemen profiting from a complex system, “PBMs came into existence with an appealing value proposition,” Blum said. “You had large manufacturers with monopolies on brand-name drugs, and individual consumers with no leverage. PBMs acted as demand aggregators to negotiate on behalf of patients. But very early on, PBMs realized that nobody really understands drug prices, and they could profit off the difference between a drug’s list price and the actual price paid.”

For independent Iowa pharmacists, that business model has real consequences. Pilkington described how PBM practices hurt not only his business, but patients he aims to serve. “It is a hard conversation to have with patients – when people must choose between getting medication and groceries that week,” he said.

Panelists pointed to meaningful reform efforts in Iowa and beyond, siting efforts in Colorado to law ban PBMs from earning income tied to the price of drugs, and New Jersey to ensure that PBMs compete openly for state employee contracts, cutting costs and lowering health premiums.

Panelists stressed that PBM-driven cost issues are not abstract. For many Iowans, the inability to afford medication is a matter of health or hardship, and community pharmacies often serve as the last line of care. The session closed with a call for increased action and continual adaptation to counter ongoing “arbitrage tricks” by PBMs.

Iowa’s early reforms mark an important step forward, but the conference made one thing clear: sustained advocacy is essential if the state is to deliver fairer prices, protect local pharmacies, and deliver better health outcomes for all Iowans.