Dr. Mattie Feldman, rheumatologist and healthcare policy expert, exposes how Pharmacy Benefit Managers have evolved from administrative entities into powerful forces that control medication access, often prioritizing profits over patients.

• Pharmacy Benefit Managers (PBMs) originally handled prescription coverage but now control what medications doctors can prescribe and patients can access
• The "big three" PBMs—CVS Caremark, OptumRx, and Express Scripts—now control 80-85% of all prescriptions in the United States
• PBMs often prefer higher-priced medications because they generate larger rebates, contributing to rising drug costs
• Vertical integration has created conflicts of interest where the same companies own insurance plans, PBMs, specialty pharmacies, and sometimes even drug manufacturing
• Utilization management tools like step therapy and prior authorizations have become barriers between doctors and patients
• PBMs force patients to use mail-order specialty pharmacies that often provide inferior care compared to community specialty pharmacies
• Legislators are working on bipartisan bills like "People Before Monopolies" that would require PBMs to divest from pharmacy ownership
• Patient stories and advocacy are crucial for creating meaningful change in the healthcare system

Share your pharmacy access or medication challenges with us by emailing [email protected] to help drive policy change.

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