How PBM Legislation Would Transform the Industry

The pharmacy benefit manager industry could look a lot different soon if Congress follows through with bipartisan efforts to pass bills governing the sector. PBMs such as CVS Caremark, Express Scripts and OptumRx would face new transparency requirements that would give health insurance companies, employers, customers and regulators new insights into how they negotiate prices for prescription medicines—and how much of the savings they generate find their way to patients and plan sponsors. Pending legislation also would prohibit lucrative practices such as spread pricing.

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