Ted Okon, Executive Director of the Community Oncology Alliance, said on April 25 that major pharmacy benefit managers (PBMs) increase drug costs and interfere with access to medications for cancer patients and others with life-threatening diseases.
"No truer words were said than that the top PBMs are the scourge of society. They fuel drug costs & get in the way of cancer patients & others w/life-threatening diseases getting their drugs. Seriously, they are just like the mob," Okon said in a post on X.
According to the Kaiser Family Foundation (KFF), PBMs serve as intermediaries in the U.S. prescription drug supply chain. They manage pharmacy benefits on behalf of insurers, employers, Medicare Part D plans, Medicaid programs, and other payers. Their functions include negotiating rebates with drug manufacturers, designing drug formularies, processing pharmacy claims, establishing pharmacy networks, and setting patient cost-sharing requirements.
The PBM industry is highly consolidated and increasingly vertically integrated. The largest PBMs often operate alongside affiliated insurers and pharmacies, giving them significant influence over formulary design, reimbursement terms, pharmacy network participation, and patient access to medications, according to a Federal Trade Commission (FTC) report.
A separate FTC analysis found that the three largest PBMs—Caremark, Express Scripts, and OptumRx—generated more than $7.3 billion in dispensing revenue above estimated acquisition costs on specialty generic drugs between 2017 and 2022. These medications included treatments for cancer and other serious diseases. The FTC also reported that in 2023, PBM-affiliated pharmacies accounted for 68% of dispensing revenue from specialty drugs, compared with 54% in 2016, and that affiliated pharmacies were reimbursed at higher rates than unaffiliated pharmacies for nearly all specialty generic drugs examined.
The Community Oncology Alliance is a nonprofit organization representing community-based oncology practices in the United States. Its leadership is composed of practicing oncologists serving on its Executive Committee and Board of Directors, and it states that its mission is focused on preserving and supporting local cancer care.
