The three PBMs that dominate the field collect more than $200 billion a year to manage prescription services for insurance carriers covering 180 million Americans and government programs serving about 110 million more. The companies are publicly-traded Express Scripts; OptumRx, a subsidiary of the insurer UnitedHealth Group; and CVS Caremark, a subsidiary of the CVS drugstore chain.

The three PBMs that dominate the field

Express Scripts

OptumRx, a subsidiary of the insurer UnitedHealth Group

CVS Caremark, a subsidiary of the CVS drugstore chain.

The PBMs are sitting at the center of a big black box. They’re the only ones who have knowledge of all the moving pieces.

LINDA CAHN, PHARMACY CONSULTANT

https://www.latimes.com/business/hiltzik/la-fi-hiltzik-pbm-drugs-20170611-story.html

pharmacy benefit management firms

https://www.forbes.com/sites/davidwhelan/2010/11/22/sebelius-mlr-rules-institutionalize-hmos-as-well-paid-health-middlemen-forever/

Nov 22, 2010,12:58pm EST

Sebelius' MLR Rules Institutionalize HMOs As Well-Paid Health Middlemen

New rules released this morning by Health Secretary Kathleen Sebelius say that HMOs must spend 80% (if they are for an individual) or 85% (for a group) of all premium dollars, net of taxes, on health care. So if you pay $15,000 a year for your family's coverage, on average $12,000 must go to doctors, pharmacies, hospitals or for other care. The rest can be spent on insurance company marketing, overhead and profits. If these so-called Medical Loss Ratios, or MLRs, are less than 80% or 85%, HMOs must provide a refund to their plan members. Sebelius estimates that 9 million people will get refunds based on the MLR rules next year.

It's no mystery why this idea became part of health reform. In many markets, and for many types of plans, HMOs were keeping as much as 30% of the premium dollars. Talk about waste.

squeezed $$$ out one place

sucked it up elsewhere

https://thehill.com/policy/healthcare/435122-senate-panel-to-hear-from-pharmacy-middlemen-on-drug-prices

The Senate Finance Committee said Thursday that it has secured commitments from executives of five major pharmacy benefit managers (PBMs) to testify next month about the high costs of prescription drugs.

Committee Chairman Chuck Grassley (R-Iowa) and ranking member Ron Wyden (D-Ore.) said executives from Cigna, CVS, Humana, OptumRx and Prime Therapeutics have agreed to appear on April 9.

https://www.forbes.com/sites/elliekincaid/2018/03/28/pharma-middlemen-have-targets-on-their-backs/

https://www.sfgate.com/business/article/Battling-a-middleman-Pharmacy-owner-says-the-2537896.php