Do pharmacy benefit managers save patients money? Doctor, government reports say no | Opinion
In a recent Kansas City Star guest commentary, Jamie Corley, executive director of the nonprofit Prescription Benefits Matter, stated that pharmacy benefit managers help Missourians afford their prescriptions. Let’s look at the studies and opinions of impartial Federal agencies, regulators and pharmacists that have investigated PBMs.
The cost of many medications in our country is outrageous, unjustifiable and in some cases unconscionable. The root causes are complex; the solutions uncertain. As a physician interacting with pharma for many decades, my opinion is that the drug industry consistently puts company profits before patients’ welfare. Additionally, careful study of agency reports demonstrates that PBMs do not lower the costs of drugs. Many, myself included, believe they increase the price of the drugs we physicians prescribe.
The Federal Trade Commission (FTC), charged with protecting the American consumer, on January 15, 2025, issued a special report on PBMs. It found they are as profit driven as pharma.
That report found “that the ‘Big 3 PBMs’ — Caremark Rx, LLC (CVS), Express Scripts, Inc. (ESI), and OptumRx, Inc. (OptumRx) — marked up numerous specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent, and many others by hundreds of percent. Such significant markups allowed the Big 3 PBMs and their affiliated specialty pharmacies to generate more than $7.3 billion in revenue from dispensing drugs in excess of the drugs’ estimated acquisition costs from 2017-2022. The Big 3 PBMs imposed markups of hundreds and thousands of percent on numerous specialty generic drugs dispensed at their affiliated pharmacies — including drugs used to treat cancer, HIV, and other serious diseases and conditions.”
Being in the PBM business is very, very profitable, according to the report: “the Big 3 PBMs also separately generated an estimated $1.4 billion of income from spread pricing — i.e., billing their plan sponsor clients more than they reimburse pharmacies for drugs.”
Other opinions? In a 2024 report, unusually approved by Democrats and Republicans, the U.S. House Committee on Oversight found “PBMs frequently tout the savings they provide for payers and patients through negotiation, drug utilization programs, and spread pricing, even though evidence indicates that these schemes often increase costs for patients and payers.”
Missouri Medicine, the journal I edit, in a 2024 review article authored by two esteemed professors at the St. Louis College of Pharmacy, concluded “their practices (PBMs) are harming the healthcare arena and the patients they serve.”
Affordable drugs should be a national objective. Pharmacy benefit managers, as they presently exist, are part of the problem rather than the solution.
This story was originally published July 1, 2025 at 5:06 AM.