Instant Insights The Prescription Drug Problem & PBM Reform

As lawmakers scrutinize the nation's pharmacy benefit managers, the California insurer expects to save $500 million in annual drug costs by replacing most of CVS Health's PBM services by January 2025.

The Federal Trade Commission launched its inquiry of the 6 largest PBMs in June 2022, after Sen. Chuck Grassley (R-Iowa) had pressed the commission for years to review their role in determining prices for prescriptions like insulin.

The state AGs sent a letter to Senate and House leaders, highlighting the urgent need for federal action to mandate that pharmacy benefit managers increase transparency into their practices by sharing pricing with health plans.

Cost Plus Drugs CEO Mark Cuban was invited to the White House, along with other business and government leaders, to discuss PBM reform, while a trade group for pharmacy benefit managers said they were not invited.

Cost Plus Drug Co., which sells drugs at a discounted rate, has reached an agreement with Community Health Systems, based in Franklin, Tenn., to purchase certain hard-to-source pharmaceuticals, such as epinephrine.

Sen. Bernie Sanders, chair of the Senate Health, Education, Labor and Pensions Committee, has demanded to know why Americans pay "$1,349 a month for [weight loss] prescription drugs that cost less than $5 to manufacture."

The Pfizer settlements come as GSK, a previous Zantac manufacturer, defends itself in an ongoing trial, while Sanofi, which recalled the drug in 2019 over cancer claims, agreed to pay more than $100 million to resolve its Zantac cases.

Providers, insurers and regulators need to come together to ensure the safe use of these drugs, mitigate failed treatment attempts, reduce side effects and provide better insurance plans to support patients in need.