Congress should reconsider breaking up pharmacy benefit Managers, Experts Say

Smaller lawmaker proposals to reform the PBM industry are missing the forest for the trees, according to some experts on the U.S. drug market.

Bipartisan policies in Congress meant to lower drug costs by targeting middlemen in the pharmaceutical supply chain are likely to run up against a fundamental issue: the three major pharmacy benefit managers’ chokehold on the U.S. drug market, experts said during a drug pricing transparency forum in Washington, D.C. this week.

Influential lawmakers on both sides of the aisle have gotten behind proposals to force more transparency in the sector, delink PBM compensation from the drug rebates they negotiate with drugmakers and ban PBMs from profiting off of the difference between what they charge payers and reimburse pharmacies for a drug.

But the so-called “Big Three” PBMs — CVS’ Caremark, Cigna’s Express Scripts and UnitedHealth’s Optum Rx — currently hold almost complete control over how patients access medications and the cost of those drugs.
Going after their business practices without changing that reality won’t help, experts said Wednesday during the Transparency is Rising event hosted by a coalition of small upstart PBMs.

“The solution to this can’t be just to ban existing practices. It has to be to remove the choke points that people have over particular parts of the supply chain,” said Reed Showalter, a former advisor on competition to the White House during the Biden administration and attorney with the Federal Trade Commission.

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