Big Medicine threatens your wallet and your health. But there is a solution.

Key Points:

• Pharmacy benefit managers (PBMs), which act as intermediaries in the drug supply chain, have been criticized for driving up drug costs through practices like steering patients to expensive drugs and charging hidden fees, despite their stated goal of reducing costs.
• The "big three" PBMs—CVS Caremark, Cigna’s Express Scripts, and UnitedHealth Group’s Optum Rx—control 80% of U.S. prescriptions and are vertically integrated with insurance companies and pharmacies, leveraging market power to increase prices and push independent pharmacies out of business.
• Drug wholesalers McKesson, Cencora, and Cardinal Health dominate 96% of U.S. drug distribution and are also vertically integrated, leading to conflicts of interest where profit motives may influence medical treatment decisions, as evidenced by legal settlements over kickback allegations.
• Recent reforms have limited some PBM practices, such as banning rebate pocketing and protecting independent pharmacies in Medicare Part D, but have not dismantled the vertically integrated business models; states like Arkansas and Tennessee have passed laws to ban PBM ownership of pharmacies, potentially reducing drug prices.
• The proposed federal Break Up Big Medicine Act aims to prohibit insurers, PBMs, and wholesalers from owning healthcare providers to increase competition and lower costs, gaining broad public support and endorsements from business leaders, with advocates comparing it to historic antitrust measures like the Glass-Steagall Act.