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.

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

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.

While existing proposals to regulate pharmacy benefit managers (PBMs) are discussed on a bipartisan basis in Washington, some experts argue that more needs to be done. Specifically, experts argue that PBMs, especially the “Big 3,” have the resources to work around legislation if it is not comprehensive.