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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

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

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

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

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 House Judiciary Committee today released an interim staff report " When CVS Writes the Rules: How CVS Protects Itself From Innovation and Competition ," unveiling how CVS Health leveraged its PBM and adjusted its business practices to eliminate independent pharmacy competition. As the Committee's press release points out, "CVS Health's own CEO characterized his company's actions best by writing: 'another example of a large PBM not allowing the small guys to compete.'" To

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

A new investigation by Hunterbrook takes a closer look at little-known subsidiaries, known as group purchasing organizations (GPOs), in the U.S. prescription drug market. As the PBM Accountability Project has previously called out since the first GPO was established in 2020, these shell companies were created by major health insurers and affiliated PBMs, allowing these conglomerates to quietly keep billions meant to lower employers’ and patients’ drug costs, even while p

(OptumRx, owned by UnitedHealth Group) 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 middl

(CVS Caremark, owned by CVS Health) 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