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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

Ahead of the House Energy and Commerce Health Subcommittee's hearing on “Lowering Health Care Costs for All Americans” today, PBM Accountability Project Managing Director Mark Blum sent a letter to thank members for their work to advance comprehensive reforms of pharmacy benefit managers (PBMs) and other insurance middlemen, and continued efforts to lower healthcare costs and ensure access to prescription medicines. “Your hearing series on healthcare affordability is a critic

Congress passed and President Trump signed a bipartisan spending bill today with several key provisions to hold pharmacy benefit managers (PBMs) accountable. Mark Blum, managing director of the PBM Accountability Project, issued the following statement:   “Today’s passage of PBM reform legislation marks an important milestone in our fight to make the prescription drug system more transparent, accountable and affordable for hardworking Americans. The PBM reforms in the spendi

The House Energy and Commerce and House Ways and Means Committees recently held hearings on the rising cost of healthcare, shining a spotlight on how PBMs and insurers are driving out-of-pocket costs for prescriptions and why reform is urgently needed.   Members from both parties agree that PBMs and other insurance middlemen are limiting access and raising costs. As Chairman Morgan Griffith (R-VA) emphasized in his opening remarks the lack of transparency and complexity of t

The U.S. House of Representatives today advanced the bipartisan spending bill with several PBM reforms. Mark Blum, managing director of the PBM Accountability Project, issued the following statement: “Today’s House vote advances long-overdue PBM reforms that rein in abusive corporate middlemen practices, marking a critical step toward making healthcare more affordable for Americans. The Senate must now act without delay to put patients over profiteers and send this package t