PhRMA announced in a blog post that policymakers should hold insurers and pharmacy benefit managers (PBMs) accountable for practices that raise patient costs and restrict access to doctor-prescribed medications.v
According to PhRMA, patients’ access problems are not solely about what is prescribed but also whether insurer-controlled coverage rules permit it. The group highlights insurer "vertical integration" with PBMs and pharmacy ownership, suggesting that consolidation increases market power and enables steering to affiliated pharmacies. These issues are currently under federal scrutiny.
The Federal Trade Commission’s (FTC) July 2024 report on PBMs revealed that major players in the industry are profiting significantly at the expense of patients and local pharmacies. The report highlighted practices such as steering patients to PBM-owned pharmacies and using complex rebate systems. Lawmakers, including Chiffy, advocate for reforms like banning spread pricing and increasing transparency.
According to Axios, an analysis of financial data shows that the three largest PBMs—CVS Caremark, Express Scripts, and OptumRx—generated over $7.3 billion from 2017 to 2022 by marking up specialty generic drugs significantly. Experts suggest these practices inflate drug prices while pressuring local pharmacies, prompting calls to decouple PBM profits from medication costs.
PhRMA is a U.S. trade association for biopharmaceutical research companies. It states its mission is to advocate for public policies that encourage the discovery of important new medicines for patients, publishing research and policy materials focused on innovation, affordability, and access across the healthcare system.
