Diana Lynn Harshbarger, representative for Tennessee’s 1st Congressional District, said on May 18 that pharmacy benefit managers (PBMs) have too much control over prescription drug coverage, pharmacy access and patient costs.
“3 PBMs control roughly 80% of the prescription drug market. These middlemen decide what drugs are covered, which pharmacies survive, and how much patients pay. It’s time to shine a light on their shady practices, restore fair competition, and bring healthcare costs down,” Harshbarger said on X.
PBMs play a central role in the U.S. prescription drug market, affecting which drugs are available to patients and how much they pay for them. Harshbarger said greater transparency and fairer competition are needed to bring health care costs down.
PBMs operate between drug manufacturers, insurers, employer health plans, Medicare Part D plans, Medicaid programs, pharmacies and patients. Their functions include negotiating rebates and discounts, processing claims, reimbursing pharmacies, designing pharmacy networks, building formularies, setting utilization rules and establishing cost-sharing requirements.
According to KFF, the top three PBMs—OptumRx, Express Scripts and CVS Caremark—managed 79% of U.S. prescription drug claims for 270 million people in 2023.
The concentration of the industry gives these companies significant influence over prescription access and payment terms across both public and private coverage. A Federal Trade Commission report found that PBM-affiliated pharmacy dispensing revenue above estimated acquisition cost increased at a 42% compound annual growth rate from 2017 through 2021, with the top 10 specialty generic drugs generating $6.2 billion in such revenue over that period.
Harshbarger represents Tennessee’s 1st Congressional District and has worked as a licensed pharmacist and business owner for more than three decades. Her official biography lists health care reform among her priorities; she serves as a member of the House Energy and Commerce Committee and vice chair of the Subcommittee on Health.
Alerts Sign-up