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(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

(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

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

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

As Congress prepares for the final legislative push of 2025, a new report from the Congressional Budget Office (CBO) reinforces the need...

As Congress returns this fall, there are likely several items on their “To Do” list – addressing healthcare costs should be near the very...

Hospitals and clinics in the 340B program often use pharmacy benefit manager (PBM) affiliated or owned contract pharmacies to dispense...

Respondents support policies to require pharmacy benefit managers (PBM)s to provide value, lower patient drug costs Carson City, NV  – As...

By: Claire Sachs, Founder of the Patient Advocate’s Chronicle and a  DPAC Champion Corps member Millions of Americans afflicted with...

The Senate Judiciary Committee held a hearing this week titled, “PBM Power Play: Examining Competition Issues in the Prescription Drug...

A recent report found that the dominance of pharmacy benefit managers (PBMs) in the 340B drug pricing program benefits these large...

In today’s healthcare landscape, few issues affect patient access and affordability as much as PBM practices. With 80% of the PBM market...

Millions of rural Americans face a devastating health crisis. They suffer from high rates of chronic diseases yet face a severe shortage...

Recent public financial disclosures from major health insurance conglomerates like CVS Health  have shed light on a concerning trend: the...

Last week, the House Energy and Commerce Committee’s Subcommittee on Health held a hearing entitled, “An Examination of How Reining in...