PBMs are beginning to leverage their overseas operations to produce biosimilars of high-demand biologic drugs like Stelara and Humira. While increasing access and dropping prices, this practice also means PBMs are in complete control of pricing and decreased competition.

45 state attorneys have joined a call to the federal government to increase transparency in prescription drug pricing. The coalition of state attorney generals asks the Department of Labor to commit to coordinated enforcement of transparency, including potential violations of state laws.

Mark Cuban explains the importance of divestment of the biggest insurance companies, the power employers have, and why doctors are still the good guys in this video excerpt from an interview with JAMA Editor in Chief Kirsten Bibbins-Domingo.

This article outlines current federal legislative and regulatory movement around PBMs. 

The FTC reached a no-fine, no-penalty settlement with Cigna’s PBM, Express Scripts. Instead, the company will implement business model changes. The lawsuit centered around Express Script’s insulin pricing and allegations of driving up prices.

West Virginia v. UnitedHealth Group Inc (No. 25-cv-00267, U.S. District Court for the Northern District of Virginia) alleges that Optum, United HealthGroup’s PBM, oversupplied opioids to patients, punished those who imposed dispensing limits, and accepted payments from opioid manufacturers.

Three months after California Governor Gavin Newsom signed a new state law into effect, small pharmacies in the state are waiting to see if it has its intended effect. This law prevents PBMs from favoring their pharmacies, places parameters on a PBM’s income, and creates new provisions around penalties and violations.

Chairman Mike Crapo (R-Idaho) and Ranking Member Ron Wyden (D-Oregon) introduced the Pharmacy Benefit Manager (PBM) Price Transparency and Accountability Act. This bill would remove compensation tied to negotiated rebates, create new Medicare reporting requirements, and require PBMs to give Medicaid payments directly to participating pharmacies, among other things.

Using 2022 and 2023 data on prescription drug plan (PDP) lives and the PBMs used by insurers to manage them, this paper presents a descriptive analysis of PBM markets.

Press Release | AMA analysis that adds to growing concern over anticompetitive harm resulting from low competition and high vertical integration in the PBM industry.