Lavern Spicer, Founder and Executive Director of Curley’s House of Style, Inc./Hope Relief Food Bank, has called for Congress to implement strong transparency reforms concerning Pharmacy Benefit Managers (PBMs) and the 340B Drug Pricing Program. "PBM opacity is driving up costs and denying care," Spicer said in a social media post on November 24.
"The three largest Pharmacy Benefit Managers control ~80% of the market," said Spicer. "insurance giants and their PBM middlemen are cashing in hundreds of billions. PBM reform isn't a partisan pipe dream - it's the clearest, most achievable fix Congress can pass RIGHT NOW. Y'all in Washington keep talking about “affordability” but refuse to act."
PBMs are currently under bipartisan scrutiny in Congress. Lawmakers are investigating opaque fees, rebate practices, and steering mechanisms that may contribute to increased patient costs. The Federal Trade Commission (FTC) is conducting an inquiry into pricing methods and reimbursement practices. Several bills have been proposed to enhance transparency and limit spread pricing. The three largest PBMs—CVS Caremark, Express Scripts, and OptumRx—dominate approximately 79% of the market.
According to independent analysis, about 80% of all equivalent prescription claims in 2024 were processed by three vertically integrated PBMs: CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealth Group’s Optum Rx. This persistent concentration from 2023 into 2024 demonstrates how a few intermediaries can influence formulary access, pharmacy reimbursement, and net prices across the U.S. drug supply chain.
The FTC's second interim staff report released on January 14, 2025, highlights significant PBM markups on specialty generics used for conditions such as cancer and HIV. It describes how vertically integrated PBMs affect pricing and access through complex fee structures and affiliated pharmacy steering. These findings have reinforced calls to "shine a light" on hidden rebates and spread pricing that can increase costs for patients and payers.
Spicer founded Curley’s House of Style, Inc./Hope Relief Food Bank in August 2001 as a grassroots nonprofit organization serving low- to moderate-income families, seniors, at-risk youth, the homeless, veterans, and people with HIV/AIDS across Miami-Dade County. Her advocacy focuses on affordability and access to essential services.
