Escalating Battle Between Pharma and PBMs Heats Up in Washington

The pharmaceutical industry and pharmacy benefit managers (PBMs) are engaged in a renewed battle in Washington, D.C., as the Trump administration takes shape. PhRMA, the drug industry's leading lobbying group, has released its policy priorities for 2025, advocating for measures that would prioritize patients' needs over PBM profits.

PBMs like CVS Caremark have defended their role in delivering lower-cost prescription drugs. However, their practices are facing increased scrutiny over the potential for higher rebates and out-of-pocket costs for patients.

CVS Health's Prem Shah maintains that PBMs lower branded drug costs and facilitate generic drug use, resulting in significant savings for clients. He also highlighted Trump's 2018 law allowing pharmacists to inform patients about lower-cost options, which reduced PBM influence.

Despite these efforts, new players have emerged to offer low-cost prescription access, including Walmart, GoodRx, Cost Plus Drugs, and CVS's own CostVantage. Shah emphasizes that PBMs remain essential for health insurance companies, despite the competition.

Telehealth companies and online platforms are also partnering with drug companies and offering low-cost drugs. However, these new ventures have not diminished the need for PBMs, according to Shah. In 2024, the PBM business generated $178 billion in revenue for CVS.

Keywords:

* Pharmaceutical industry
* Pharmacy benefit managers
* PBMs
* CVS Caremark
* Generic drugs
* Health insurance
* Trump administration
* Drug costs
* Patient choice