News

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

Last week marked an important milestone as President Trump signed a bipartisan bill that includes several key provisions to hold PBMs accountable. After many years of countless voices sounding the alarm on PBMs’ role in driving up prescription drug costs, federal policymakers have taken a meaningful step to curb abusive PBM practices and begin repairing a prescription drug pricing system that has failed patients, communities and pharmacies for far too long.   Patients and ca

The House Energy and Commerce Health Subcommittee’s latest hearing, Lowering Health Care Costs for All Americans: An Examination of the Prescription Drug Supply Chain , made clear that historic PBM reform is only a first step, not the finish line.   Chairman Brett Guthrie (R-KY) highlighted how the drug supply chain has seen significant vertical integration across insurers and wholesalers that now own and operate provider groups, pharmacy services, GPOs, pharmacies and even w