PBMs have evaded lawmakers’ reform attempts so far. Could 2025 turn the tide?

According to critics, PBMs drive up drug costs through an opaque rebate system, and their joint ownership structure with pharmacies and health insurers creates an unfair and anticompetitive business model. Just three companies — CVS’s Caremark, Cigna’s Express Scripts and UnitedHealthcare’s OptumRx — control the vast majority of the PBM market. And their concentrated and complex operations have been catching heat amid calls for drug pricing reform.