UnitedHealth, CVS, and Cigna leveraging market power and political influence to push independent pharmacies out.

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Pharmacy benefit managers (PBMs) are the shadowy middlemen who decide what drugs you can buy, where you can buy them, and at what cost—without disclosing how much they charge to your employer, to your doctor, or your pharmacist. And as HEALTH CARE un-covered has reported, the biggest PBMs are now owned by Big Insurance.

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PBMs are a poorly understood component of America’s permanent and escalating health care snafu, but they are a growing presence in our lives. Their business practices have created administrative and financial barriers to the prescription drugs patients need, even as PBMs’ Big Insurance owners rake in record profits.

A new Biden administration rule may rein in some of the worst practices of PBMs. But in response—and to protect profit margins—the PBM/Insurance industry, led by UnitedHealth’s Optum, Cigna’s Express Scripts, and CVS’s Caremark, has launched a full-on onslaught against independent pharmacies by dropping reimbursement rates. Many independents are being forced out of business. With them out of the picture, the PBMs will be better able to steer patients to their own pharmacies, mail-order operations, and, at least in Cigna’s case, big investor-owned corporations like Walgreens that they’ve struck deals with.

Last year, Republican Ohio Attorney General Dave Yost said that “PBMs are modern gangsters,” and that “they were designed to protect and negotiate on behalf of employers and consumers after Big Pharma was criticized for overpricing medications, but instead they have absolutely destroyed transparency, scheming in the shadows to control drug prices on all sides of the market.”

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