BGOV OnPoint: PBM Business Practices Under Scrutiny

Lawmakers are making another push to crack down on pharmacy benefit managers, an industry that’s been thrust into the spotlight in the debate over high drug prices in the US.

PBMs have shifted their business models amid the growing scrutiny, relying less on revenue from drugmaker rebates and instead finding new profit sources. The largest three PBMs — CVS Caremark, Express Scripts, and Optum Rx, which control nearly 80% of the market — are leveraging vertical integration with pharmacies, insurers, drugmaker affiliates, and other entities in the drug supply chain.

Federal bills to require PBMs to pass ...