PBM Issues

Excessive prescription refilling by mail-order pharmacies leaves piles of unneeded pills; 'Every time, there are 15 extra' The Wall Street Journal Reporters: Christopher Weaver , Tom McGinty , and Anna Wilde Mathews U nitedHealth Group’s pharmacy mailed Medicare recipient Bill Zielinski so many refills of the cholesterol drug atorvastatin that his unused stash could last a year on the pill-a-day regimen his doctor ordered. Excessive refilling is common practice at U.S. mail-

The Independence Bucks County Author: Dr Marion Mass On January 10, 2024, 22-year-old Cole Schmidtknecht of Appleton, Wisconsin, went to his big-box pharmacy and was told that a preventative asthma inhaler he had relied on for years was no longer covered by his insurer. He would have to pay over $500 for it — out of pocket. Cole left without the inhaler. On January 21, 2024, he died as a consequence of a severe asthma attack. His father, Bil, who had the same insurance provi

Real Clear Health Reporter: Justin Leventhal In the past decade, independent drugstores have been vanishing, especially in low-income, minority, and rural communities, in part due to pharmacy benefit managers (PBMs) having rigged the system in favor of their own pharmacies. By steering patients to in-house pharmacies and squeezing independent pharmacies with hidden fees,  PBMs are driving local pharmacies out of business . This loss of competition hits vulnerable communities

You’ve probably heard of ghost kitchens, those restaurants that exist only on delivery apps with no physical storefront for customers to visit. But have you ever heard of ghost networks? They’re not spooky Halloween décor or the latest streaming conspiracy. Ghost networks are the phantom pharmacy networks that pharmacy benefit managers and insurance companies claim to exist on paper, but have little basis in reality. If you’ve ever tried to help a patient find an in-network p

Are We Talking About the Same Middlemen?  Following President Trump’s announcement today of “TrumpRx”, a new executive initiative to help lower patient drug costs, we thought  for a minute the Chief Executive might have gotten pharmacies confused with PBMs.  Currently there are not enough details to know exactly what TrumpRx is or how it would work, but we can all agree that patient safety cannot be compromised by removing access to trusted pharmacy professionals. Even if Tru

Author: Kayla Copeland At the heart of Tennessee’s PBM reforms is the Maximum Allowable Cost (MAC) law. A MAC is the reimbursement cap a...

How the CBO Became PBMs’ Sidekick If you think the biggest obstacle to fixing PBMs is their billion-dollar lobby, bless your heart, because you’re only half right. The other half? A government spreadsheet in D.C. quietly strangling real reform before it ever has a chance. Meet the Congressional Budget Office (CBO). The unelected, unaccountable scorekeeper that can take a bipartisan, common-sense bill and file it under “too expensive” with the click of a keystroke. Officially,

NoLa.com Author: Monique Whitney, PUTT Executive Director Recently guest essayist Rob Maness suggested banning pharmacy benefit managers...

Northwest Arkansas Gazette Reporter: Nathan Ansell Twelve pharmacy benefit managers have been found in violation of a rule requiring...

WebWire The American Medical Association (AMA) today published a  new annual analysis  (PDF) measuring competition in pharmacy benefit...

How ERISA, Medicare Part D, and their New “Mandate” Smokescreens Keep States from Cleaning Up the PBM Mess Every time a state passes a law to hold pharmacy benefit managers (PBMs) accountable — whether it’s banning spread pricing, requiring fair reimbursement, or protecting patient choice — you can bet the PBM lawyers are already in the wings, sharpening their favorite legal sword: preemption. The two blades they use most often? ERISA and Medicare Part D. But lately, the PBM

Ohio Capital Journal Reporter: Marty Schladen Owners of small pharmacies — many themselves members of local chambers of commerce — are...

The Federalist Author: Drew Johnson Why do we have a medical system in this country where too many people can’t get the treatment that...

May 27, 2025 Anticompetitive Regulations Task Force  United States Department of Justice  950 Pennsylvania Avenue NW  Washington, DC 20530 Re: Anticompetitive Practices by Vertically Integrated Health Insurers and Pharmacy Benefit Managers Dear Members of the Anticompetitive Regulations Task Force: I am writing on behalf of the independent pharmacy members of Pharmacists United for Truth and Transparency (PUTT) to bring to your attention the urgent need for antitrust enforcem

PUTTbulletin May 2025 Something is seriously wrong with military prescription drug pricing, and it's time we talked about it. In the coming weeks PUTT will launch what we hope to be a provocative campaign focused on some troubling - but largely unacknowledged - questions: why are our military families and taxpayers paying dramatically inflated prices for generic prescription drugs through Tricare's PBM, Express Scripts? And what are we doing about it? It’s a Problem We Can’t

Duluth News Tribune OPINION: by PUTT President, Deborah Keaveny On March 21, pharmacist Philip Hommerding was busy dispensing medications...

The program was supposed to save the government money. It doesn’t. The Washington Post Editorial Board Republicans in Congress have made...

Let’s cut the nonsense: pharmacy benefit managers (PBMs) aren’t just shady middlemen—they’re operating a masterclass in anti-competitive...

The worst marriage in the history of healthcare is the unholy union of PBMs (pharmacy benefit managers) and formulary design. This carefree couple has fostered the creation of inconceivably high priced brand drugs in the U.S. market for decades, and we need an immediate annulment. Plan formularies are more influenced by quid pro quo payments between PBMs and drugmakers than clinical guidelines. Thanks to a safe harbor exemption from the Anti-Kickback Statute, PBMs can legall

The state officials claim that ownership limits competition Consumer Affairs Reporter: Mark Huffman Key takeaways State attorneys general...