There's a problem

About PBMs

with PBMs.

Pharmacy benefit managers (PBMs)
started as a good idea.

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They’d use their buying power to negotiate for lower drug prices from manufacturers and pass the savings on to their members.

But before long, PBMs started to consolidate. Now, 75% of the entire market is run by 3 PBMs owned by Cigna, CVS, and UnitedHealth. And since the pricing for their drugs is kept secret, their focus has shifted to chasing profit for themselves — through spreads and rebates — instead of passing on savings to you and your employees.

Read about common problems with
prescription drug pricing and PBMs.

The Wall Street Journal:
“How Drug Prices Work”

Watch this video to learn why drug pricing has become so complicated — and how PBMs contribute to the confusion and rising costs.

See the video.

The New York Times:
“Why Your Pharmacist Can’t
Tell You That $20 Prescription
Could Cost Only $8”

Some PBMs try to stop consumers from finding out when their copay for a drug is higher than the list price. One strategy: Imposing gag orders on pharmacists.

Read the article.

60 Minutes: “The problem with
prescription drug prices”

Sky-high prescription drug costs threatened to bankrupt an entire town. Now, the town is suing a pharmaceutical manufacturer and a PBM.

Find out how they’re fighting back.

Modern Healthcare: “CVS’
pharmacy benefit manager
unit sued for false claims.”

The PBM owned by CVS — CVS Caremark — was hit with a lawsuit for illegally charging Medicare more than it was paying pharmacies for medications.

Learn more about the lawsuit.

Karen Van Nuys, PhD et al:
“Overpaying for Prescription
Drugs: The Copay Clawback Phenomenon.”

This study from USC’s Center for Health Policy & Economics delves into the economics of prescription drug overpayments.

Read the study [PDF].