STAT+: White House is told the big three PBMs are ‘everything wrong with this industry’
As part of its battle to blunt the growing cost of medicines, the White House on Monday held a so-called listening session in hopes of finding ways to reign in big pharmacy benefit managers, which occupy an opaque but crucial role in pharmaceutical pricing in the U.S.
The gathering resembled something of a fact-finding mission as a small group of policymakers and business people briefly shared their experiences dealing with the largest industry middlemen, who negotiate with drugmakers on behalf of insurers and employers and, in the process, create formularies or lists of medicines that are covered by insurance.
But critics say the three biggest pharmacy benefit managers — CVS Health, OptumRx, and Express Scripts — run opaque businesses that drive up costs for patients and taxpayers by favoring their own pharmacies over independent drug stores and forcing drug companies to raise prices that cover the cost of rebates needed to win favorable formulary placement. These three companies control 80% of the U.S. market.
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