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The PBM Accountability Project members and partners are highlighting a shared concern: PBMs and vertically integrated insurers are creating real barriers to patient affordability and access. Watch new video testimonials underscoring the urgent need for meaningful PBM reform: Emma Freer, Senior Health Policy Analyst, American Economic Liberties Project How has vertical integration in the health insurance industry affected patient choice, medication access and drug pricing fai

Pharmacy benefit managers have been playing cat and mouse with regulators for years now, and by most measures, they've been winning. The pattern is familiar enough: scrutiny builds, a PBM announces sweeping reforms, the money moves to a new subsidiary, and business continues. Federal regulators have now reached proposed settlements with three of the country's largest PBMs, a notable victory that follows substantial Congressional action earlier this year. But the history here

Every American who fills a prescription would assume generic options are the bargain that keeps drug costs down. A deep new analysis from drug-pricing researchers at 46brooklyn shows how that bargain is being quietly broken – and how the middlemen running the system are cashing in. The report highlights how pharmacy benefit managers (PBMs) are labeling cheap generic drugs as high-cost "specialty" medications – and then reimbursing their own affiliated pharmacies at rates doz

Every election cycle, candidates promise to lower healthcare costs. What's missing is a straight answer about who's standing in the way, and what it would actually take to fix it. Here's the encouraging part: Lawmakers from both parties have spent years scrutinizing pharmacy benefit managers (PBMs), and the verdict has been remarkably consistent: the current system isn't working, and the middlemen running it need to be held accountable. PBMs sit between drug manufacturers and

This week, the House Energy and Commerce Subcommittee on Health convened a hearing on lowering healthcare costs for all Americans, and the message was consistent: the status quo isn't working. Chairman Brett Guthrie (R-KY) highlighted how rebates designed to benefit patients are instead being routed to group purchasing organizations, leaving consumers no better off. The fix, he pointed out, starts with transparency. Rep. Debbie Dingell (D-MI) took direct aim at vertical int

This week, the House Energy and Commerce Subcommittee on Health will hold a hearing titled, “Lowering Health Care Costs for All Americans: Examining Policies to Increase Health Care Transparency." Mark Blum, managing director of the PBM Accountability Project, issued the following statement: “This latest hearing on transparency once again reiterates the importance of bringing greater accountability to the healthcare system. The role of vertically integrated insurance corporat

The 340B program exists to help safety-net hospitals and clinics serve low-income and uninsured patients. But when savings meant to reach patients never arrive, patients lose out on care. That's exactly what three major health systems are now claiming in federal court. Hospitals owned by Mount Sinai, the University of Michigan Health and the University of Kansas sued CVS Health this week for allegedly stealing hundreds of millions of dollars in 340B savings. The lawsuits alle

When the Department of Labor (DOL) closed the comment window on its proposed PBM fee disclosure rule, the verdict was in: of the more than 560 comments, over 80% of letters expressed support for transparency, including from 180+ key stakeholders. A surge of 335 comments on the final day alone highlights just how much is at stake. The PBM Accountability Project, along with more than 75 other organizations, support the proposed rule. Patient advocates, independent pharmacies, p

Each year, premiums go up, deductibles increase, and insurers and their affiliated PBMs make record profits. In recent years, investigations and hearings have been uncovering how this happens. During a 2025 congressional hearing on PBM practices, Witness Dr. Hugh Chancy, a Georgia pharmacist and former president of the National Community Pharmacists Association, described a story of a customer whose prescription cost $135 at the pharmacy – yet their insurance plan was bille

The U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee traveled to Louisiana recently for field hearings focused on improving healthcare affordability. The hearings brought together patients, providers and local experts to discuss the growing challenges facing communities across the country. Throughout the hearing, witnesses described a healthcare system that’s increasingly difficult to navigate, including growing concerns over the influence of vertically int

The House Education and Workforce Committee's Subcommittee on Health, Employment, Labor, and Pensions recently held a hearing on how pharmacy benefit managers are driving up prescription drug costs at the expense of American employers and patients. Members on both sides of the aisle condemned PBM practices as opaque, anti-competitive and costly. The primary legislative focus was Chairman Rick Allen's (R-GA) PBM Kickback Prohibition Act, which would prohibit PBMs from paying

What if insurer middlemen stood between you and a life-saving medication? This is the case for far too many Americans. Brandon was a 52-year-old accountant from Texas diagnosed with stage III colon cancer. He battled it into remission - until it came back at age 56. His community oncologist prescribed an oral chemotherapy designed for patients in his situation. His prescription was sent to a specialty pharmacy. That pharmacy couldn't fill it and passed it to a second. The sec

The House Committee on Ways & Means will hold a hearing on April 21 titled “ Protecting Patients & Taxpayers: Cracking down on Medicare Fraud .” Mark Blum, managing director of the PBM Accountability Project, issued the following statement: “The PBM Accountability Project welcomes the House Ways & Means Committee’s focus on identifying and addressing fraud in the Medicare program. As lawmakers examine vulnerabilities that drive unnecessary costs for taxpayers and beneficiari

This week, the Senate Health, Education, Labor & Pensions (HELP) Committee will hold a hearing titled, ” Making Medicines More Affordable: How Competition Can Lower Drug Prices .”Mark Blum, managing director of the PBM Accountability Project, issued the following statement:  “This latest hearing comes at a critical moment. What was once a marketplace built on consumer choice and fair negotiation has become increasingly dominated by vertically integrated insurance conglomerat

Ahead of the U.S. Department of Labor’s review of its proposed rule , Improving Transparency into Pharmacy Benefit Manager Fee Disclosure , the PBM Accountability Project led a coalition of national organizations in sending a letter to Secretary Lori Chavez-DeRemer applauding the Department’s leadership in advancing long-overdue, common-sense guardrails to rein in the unchecked influence of PBMs over employer-sponsored prescription drug benefits. “We have seen undeniable ev

Pharmacy benefit managers (PBMs) are once again resorting to misleading claims in a continued effort to deflect from the growing scrutiny their industry faces – from investigations and legal challenges to bipartisan calls for meaningful reform. This time, the PBMs’ national trade organization, PCMA, is mischaracterizing the conclusions of a recent report around commonly used asthma medication. PCMA is once again predictably misrepresenting the true drivers of inhaler list

PBM Accountability Project recently submitted a comment to the Federal Trade Commission strongly supporting its proposed Decision and Order against Express Scripts, Inc., Evernorth Health, Inc., Medco Health Services, Inc., and Ascent Health Services LLC . As a coalition of leaders and stakeholders across healthcare, labor, business, pharmacy, and patient and consumer advocacy, we view this enforcement action as a critical step toward restoring transparency, fairness and acco

This week, the House Committee on Energy and Commerce Subcommittee on Oversight and Investigations will hold a hearing titled, “ Protecting Patients and Safeguarding Taxpayer Dollars: The Role of CMS in Combatting Medicare and Medicaid Fraud .” Mark Blum, managing director of the PBM Accountability Project, issued the following statement: “The PBM Accountability Project welcomes the Committee’s focus on rooting out waste, fraud and abuse in Medicare and Medicaid and urges l

Insurer owned PBMs are no longer just middlemen; they are the architects of many of the drug pricing and access abuses patients and providers are fighting every day. Nearly 80% of all prescription claims run through three PBMs owned by CVS Health/Aetna, Cigna’s Evernorth and UnitedHealth Group, giving these conglomerates the power to design the benefit, control the pharmacy network and capture the spread between what is paid in and what is paid out. Behind familiar complain

(3 Axis Advisors) Escalating healthcare spending and growing concern over medical debt have intensified calls for greater transparency in U.S. hospital pricing. In response, federal policymakers implemented the Hospital Price Transparency Rule — requiring hospitals to publicly disclose detailed “standard charges,” including gross charges, discounted cash prices, and insurer-specific negotiated rates. The intent behind this policy is clear: to reduce long-standing information

(The Washington Times) - - Opinion by U.S. Rep. Buddy Carter (R-GA) The PBM Reform Act, which I introduced earlier this year with a bipartisan group of colleagues, reins in pharmacy benefit managers (PBMs). The top three PBMs process nearly 80% of all prescription drugs dispensed by pharmacies. These PBMs have been manipulating drug prices and restricting access to affordable medication for their own financial benefit for decades. With this legislation, we took measurable ste

(RealClearHealth) - - Opinion by U.S. Senate Finance Committee Chairman Mike Crapo (R-Idaho) It is no secret that health care policy is a frustrating topic on Capitol Hill. That frustration reflects the worry felt by Americans searching for affordable health insurance and pharmaceutical options amid an opaque, complex and costly system. While Republicans and Democrats agree our health care system is broken, we often have very different ideas about what reforms will sustainabl

Health insurers and their affiliated pharmacy benefit managers (PBMs) have brought in yet another middleman – Group Purchasing Organizations (GPOs) – to the already complex and opaque health insurance web. GPOs act as additional pass-through, shell corporations vertically integrated with insurers and their PBMs and pharmacies – several are headquartered overseas, making U.S. oversight difficult. PBMs use GPOs to rebrand rebates as “administrative fees,” letting them pocket m

President Trump touched briefly on affordability of healthcare in his record 1 hour and 40-minute State of the Union address Tuesday evening. Mark Blum, managing director of the PBM Accountability Project, issued the following statement: “Affordability of healthcare is a top concern for America’s working families – particularly when it comes to the cost of prescription drugs. President Trump has rightly focused attention on the exploitative business practices of insurance co