Pharmacy Benefit Managers, often known simply as "PBMs," are largely unrecognized by most employees—and even by many employers. But they have a tremendous impact on U.S. health care decision-making. Three large companies—Express Scripts, CVSHealth and OptumRx—cover more than 180 million lives, or roughly 78% of the market, and while their role is largely unnoticed, employers and government entities must be vigilant as the non-transparent nature of the traditional PBM business model can add hidden costs and lead to higher prices.
"Expansions of prescription drug coverage over the past 10 years mean that PBMs are involved in a majority of prescription drug transactions today. In light of that fact, transparency regarding the PBM industry is needed so that purchasers of these services in both in the commercial and government sectors can make well-informed decisions."
- Applied Policy Report
Since 1987, when Advance PCS/Caremark (now CVSHealth) became the last of the original "big 3" PBMs to incorporate, the others being Medco and Express Scripts which merged in 2012, total prescription drug expenditures have skyrocketed 1100% and per capita expenditures have increased 756%.
The resources in this section further explain the role of PBMs in the prescription drug marketplace and how they contribute to higher costs.