CVS Exploits PBM Role, and Taxpayers Pay

Kentucky, lawmakers discovered that PBMs, including CVS, pocket over 40% of the state’s annual Medicaid spending on prescription drugs.

Opinion Letter posted in Wall Street Journal

Recently, CVS accused the Journal (Letters, June 8) of mischaracterizing its pharmacy benefit manager (PBM) operation. Thomas Moriarty is right to contend that the PBM’s role “is to negotiate the best price possible for patients and clients,” but wrong to pretend that large PBMs are accomplishing that mission.

In Kentucky, lawmakers discovered that PBMs, including CVS, pocket over 40% of the state’s annual Medicaid spending on prescription drugs. In Arkansas’s Medicaid program, independent pharmacists received $909 for 20 tablets of Temozolomide. CVS’s PBM gave its pharmacies $4,000 for the same cancer medicine.

The industry’s lack of transparency allows CVS to expand its mosaic of abusive pricing schemes with impunity. While independent pharmacists provide medical services and guidance to many (particularly rural) Americans, major PBMs like CVS Caremark are crippling these pharmacies by unfairly cutting their reimbursements. What’s worse, CVS then urges those pharmacists to sell their practices to its retail arm. Patients and taxpayers incur the financial costs of this flimflam, and patients suffer further by losing access to local health providers.

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Rep. Doug Collins (R., Ga.)

Gainesville, Ga.

Wall Street Journal