Drugmakers Paid PBMs Not to Restrict Opioid Prescriptions

Published On Dec 17, 2024, 5:00 AM

A New York Times investigation has revealed that major pharmacy benefit managers (PBMs) such as Express Scripts, CVS Caremark, and Optum Rx accepted payments from drug manufacturers, including Purdue Pharma, to keep opioid prescriptions flowing. Despite public statements aimed at combating the opioid crisis, these companies were financially incentivized to facilitate the distribution of prescription painkillers, contributing to America’s overdose epidemic which has claimed tens of thousands of lives. The investigation uncovers the complex role these PBMs play in the pharmaceutical supply chain, raising questions about their accountability and the healthcare system's structure.

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Given the significant public scrutiny and potential regulatory changes aimed at pharmacy benefit managers due to this revelation, companies involved may face legal actions and reputational damage. As health insurers and stakeholders reassess relationships with PBMs, there may be a shift towards transparency and tighter regulations, affecting profitability.

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CVS Health's Caremark, Cigna's Express Scripts and UnitedHealth Group's Optum control the majority of the U.S. pharmacy benefit market, with their parent companies also operating health insurance and pharmacy businesses. Pharmacy benefit managers negotiate drug costs with pharmacies and drug manufacturers and help build drug coverage lists for health plans, mostly on behalf of employers and the government.

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