The medical industry is riddled with regulation and red tape. It breaks down into a medical benefit vs. pharmacy benefit, each with its own nuisances that make the medical industry complex feel like a scary corn maze during a bad dream. Interestingly, Pharmacy Benefit Managers (PBMs) were originally founded in the 1960s by pharmacists as a way to help insurance companies manage drug spending, negotiate prescription drug spending, manage a formulary (a list of drugs covered by the plan without prior authorization required), and lastly to establish a list of “in-network” pharmacies.
What was intended to streamline the pharma industry and help save costs has now caused an explosion and ballooning of costs to the American people. Three particular PBMs, CVS Caremark, ESI, and Optum, now dominate about 89 percent of the U.S. market. While three does not equal a…
