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Our Principles


Four Principles for Holding PBMs Accountable

The debate over prescription drug spending has raised a number of critical questions: Who decides what people in the Granite State pay and why? Who is involved in individual transactions? And most importantly, what can be done about rising costs of prescription medications for the end purchaser?

We believe that patients and other purchasers of medicines shouldn’t pay more than is absolutely necessary.

Through this effort, we aim to provide a better understanding of the role that pharmacy benefit managers (PBMs) play in determining what consumers pay for their medications. We aim to advance key solutions to ensure that the prescription drug market meets the needs of patients and other purchasers of medicines. Below are four guiding principles of The PBM Accountability Project of New Hampshire:

  1. Public education and understanding of the role and business practices of PBMs is critically important for ensuring that New Hampshirites and our state government pay no more than is absolutely necessary for prescription drugs.

  2. PBMs should compete transparently on the basis of cost to Granite Staters; this will maximize the benefit to patients, taxpayers, and group purchasers (including the State).

  3. PBMs should be accountable for delivering the highest possible savings – that is, the most affordable prescription drug pricing – to New Hampshire group purchasers and individual patients.

  4. The lion’s share of financial savings that PBM middlemen and claims processors produce should flow directly to patients, health plan beneficiaries, and taxpayers.


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Policymakers in Congress and the states are no longer standing idly by while PBM profit margins swell at the expense of taxpayers, patients, employers, and working families.


For example, the State of New Jersey created a groundbreaking competitive marketplace for state contracting of prescription drug benefits. The online PBM reverse auction model, proposed by PBM Accountability Project partner, America’s Agenda, enabled the state to reduce its spending on prescription medicines by an unprecedented $1.6 billion over three years without imposing any pharmacy benefits cuts on public employees. Meanwhile, states like Georgia, Maryland, Illinois and Kentucky are also taking action to rein in PBM profits.

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