Pharmacy Benefit Managers Played Key Role in Worsening Opioid Crisis, Drug Makers Paid Staggering Rebates To Middlemen: NYT

Benzinga - Dec 18th, 2024

Pharmacy benefit managers (PBMs) in the U.S. pharmaceutical supply chain have been implicated in exacerbating the opioid epidemic. An investigation by The New York Times revealed that while PBMs claimed to combat opioid abuse, they profited through deals with drugmakers that bypassed safeguards against overprescribing. The three largest PBMs—Optum (UnitedHealth Group), CVS Caremark (CVS Health), and Express Scripts (Cigna)—control prescription drug access for over 200 million Americans. Lawsuits have been filed against drug companies and PBMs for inflating insulin prices. The NYT report cited internal documents showing PBMs negotiated away restrictions on opioid prescriptions in exchange for lucrative rebates from companies like Purdue Pharma. These agreements increased prescription thresholds, ignored federal guidelines, and contributed to the opioid crisis. Despite growing evidence and public pressure, PBMs delayed implementing safety measures, prioritizing profits over patient safety. Critics argue that subsequent stricter controls were driven more by public relations than a genuine effort to address the crisis. The FTC has accused PBMs of creating a financially beneficial system by prioritizing drug rebates. PBMs, however, claim that actions against them seek to disrupt established practices. Despite the controversy, stocks of PBM-related companies like Cigna, CVS, and UnitedHealth saw increases.