Aug 23, 2023
A fascinating, if somewhat imperfect, move this month by Blue Shield of California is sparking interesting questions about the future of the “Big PBM” business model and where it might go from here.
If last week’s reports of plummeting shares among CVS, UnitedHealth, Cigna and yes, even GoodRx, is any indication, Blue Shield’s decision is a harbinger of new ideas and approaches to managing pharmacy benefits, and the market is watching with interest (no pun intended).
Predictably CVS responded like the jerk ex who tells everyone post-break up that it’s not really over, telling the SEC and everyone else they’re still managing Blue Shield’s specialty medication business and since that’s where the money’s at anyway, they’ll be fine.
It’s true the money is in specialty medications and CVS certainly isn’t going anywhere anytime soon, but we find reason to be optimistic in Blue Shield’s decision to break with CVS in favor of an alternative model that uses multiple service providers, including two of the nation’s most recognizable consumer brands, Amazon and Mark Cuban Drug Company.
Even with the increase in state and federal oversight (as of today all 50 states having passed at least one PBM regulation law and some 40 PBM bills are under consideration in Congress), our healthcare system needs someone willing to try a different approach. We can’t know if alternative methods to managing pharmacy benefits will work until someone with some market influence is willing to at least try.
And so we applaud Blue Shield – more than applaud, we give them a standing ovation – for being willing to break with tradition and take a momentous step in the march toward PBM reform.
Yours in Advocacy,
Monique Whitney, Executive Director