News

(Express Scripts, owned by Cigna) It’s been well reported that the top three PBMs control nearly 80% of all U.S. prescription drug claims . They were originally established to negotiate prescription drug savings for patients, employers and taxpayers – and yet, Americans continue to face higher out-of-pocket costs for the medicines they need.   So, who are these PBMs and how can we separate fact from fiction?   Let’s take a closer look at the Big Three corporate middlemen in t

As 2025 comes to a close, one thing is clear: momentum for PBM reform is stronger than ever. Over the past year, patients, pharmacists, employers and policymakers have increasingly recognized what the PBM Accountability Project (PBMA) has long worked to expose. The current PBM middleman system drives up costs, limits patient choice and operates with far too little transparency. The growing recognition for PBM accountability translated into meaningful action at both the state

Vertical integration has impacted the prescription drug market in ways most consumers never see, but almost all feel.    There has been a significant increase in vertical integration  between PBMs and health insurers in recent years. This, along with the fact that the five largest PBMs controlled 93.6%  of the Part D market, 79.6%  of the commercial insurance market, and 71.5%  of the Medicaid managed care PBM market in 2023, means that very few corporate entities have signif

U.S. Senators Ron Wyden (D-OR) and Mike Crapo (R-ID), along with nearly 20 of their colleagues, on Dec. 4  introduced  the Pharmacy Benefit Manager (PBM) Price Transparency and Accountability Act  to “fix market distortions and increase transparency in federal prescription drug programs to lower patient costs at the pharmacy counter.” Mark Blum, managing director of the PBM Accountability Project, issued the following statement:  “We applaud Senators Crapo, Wyden and their bi

By Mark Blum, Managing Director, PBM Accountability Project  The Centers for Medicare & Medicaid Services (CMS) recently released results of a second round of CMS-negotiated Maximum Fair Prices  for selected drugs under the Inflation Reduction Act (IRA). This transparency from the agency is promising as it allows policymakers and the public to better understand how negotiated prices may influence both patient out-of-pocket costs and federal spending.    Taking a Closer Look  

In recognition of a universal desire to increase health care affordability, the Senate Finance Committee recently held a hearing titled  “ The Rising Cost of Health Care: Considering Meaningful Solutions for All Americans ”  to examine possible policy solutions. PBM reform remains the most practical, bipartisan proposal to lower costs, as committee Chairman Mike Crapo (R-ID) highlighted in his opening remarks .     Senator Mike Crapo (R - ID) mentioned PBM reform as a main is

The PBM Accountability Project Managing Director Mark Blum submitted a letter to Congressional leaders today urging them to take action to make health care more affordable for American patients by passing meaningful PBM reform legislation. The committee began working on legislation to rein in these middlemen in 2024 and must not miss an opportunity to advance legislation that prohibits the anti-patient, anti-competitive practices that have allowed PBMs to profit at the expens

Independent pharmacies play a significant role in delivering prescription medicines to Americans across the country, representing 35% of all retail pharmacies in the U.S.   In recent years, there has been an alarming and continuing rate of independent pharmacy closures - nea rly one in three pharmacies have closed since 2010, leaving almost 800 ZIP codes that had at least one pharmacy in 2015 now having none.   A primary factor behind the decline of independent pharmacies

By Mark Blum, Managing Director, PBM Accountability Project The insurance carrier Cigna’s Evernorth division issued a recent announcement that its pharmacy benefit manager ( PBM) Express Scripts will stop collecting manufacturer rebates in 2028. The announcement was the PBM equivalent of a head fake in football, an all-too-common deflection tactic well-known to those who have tracked the PBM industry since inception. The insurance company that owns Express Scripts wants poli

California’s SB 41 is a major win for PBM accountability, passing the legislature with broad bipartisan support and earning Governor Newsom’s signature this month.  This legislation is one of the strongest protections to date against anti-consumer PBM practices and includes important provisions to: require PBMs in California to be licensed and subject to oversight, ending their near-total lack of regulation in the state ban spread pricing – the practice where PBMs charge ins

The PBM industry’s lobbying arm is reportedly working to avoid new federal regulations, suggesting instead that PBMs police themselves....