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2025 outlook: Alternative PBMs look to heap pressure on industry titans

Pharmacy benefit managers were under the microscope from the Federal Trade Commission (FTC), lawmakers and states in 2024.


But outside of potential inclusions in an end-of-the-year health package on the Hill, the traditional "Big 3" PBMs managed to escape the toughest reforms. Business practices by Optum Rx, Express Scripts and CVS Caremark could change, should bipartisan efforts bear fruit. The industry’s trade group, the Pharmaceutical Care Management Association, spent millions to lobby Congress in its favor this year.




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