Despite the purported value of pharmacy benefit managers (PBMs), drug prices remain unaffordable for many Americans (“Prescription drug pricing reform must rein in pharmacy benefit managers,” Web, Oct. 18). As middlemen between the manufacturers, pharmacies and consumers, PBMs are notorious for abusive business practices that impact both patients’ wallets and their access to prescription drugs, while gouging unaffiliated pharmacies.  

As Rep. Carter and Mr. Wilcox correctly note, PBMs process the vast majority of the nation’s prescription drugs. This undue concentration of market power means they can and do restrict consumer access to expensive drugs and cause delays in treatment, all so that affiliated pharmacies dispense and earn revenues while denying competing pharmacies access to high-margin drugs. 

PBMs are not freestanding operations. They are part of huge health care conglomerates that dominate not only the PBM market, but a series of adjoining markets including health insurance, retail pharmacy, specialty pharmacy, mail-order pharmacy and long-term-care pharmacy. They have also become health care providers, which has allowed them to control the flow of medications. This anti-competitive behavior is clearly apparent in Express Scripts’ recent decision to reduce reimbursement rates for pharmacies in the TRICARE network, forcing veterans and their families to find alternate ways to access covered drugs — or simply pay for them out-of-pocket. 

Small businesses, such as the community and long-term care pharmacies that are not part of these corporate behemoths, deserve protection from unfair trade practices. Consumers deserve more than the illusion of low costs at the price of easy access to essential medications.   

To curb PBMs’ exploitative business practices, all stakeholders — including the Federal Trade Commission, Congress, the Biden administration and federal health departments — must focus on how these entities drive high drug prices, restrict access to essential medications and threaten unaffiliated pharmacies.


President and CEO, Senior Care Pharmacy Coalition


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