Amye Joseph says America's political polarization has made it an "interesting time" in her Tennessee household. She and her husband, Charlie, have been married for 35 years. But their shared disenchantment with profit-driven healthcare has provided a unifying target: pharmacy benefit managers, known as PBMs.
This story was produced in partnership with KFF Health News. The Josephs' frustration is focused on CVS Health. The conglomerate, which reported $400 billion in revenue last year, includes a major health insurer (Aetna), one of the country's dominant PBMs (CVS Caremark), and America's largest retail pharmacy chain (CVS Pharmacy).
I'm going to be straight-up," Amye Joseph said. She laments the lack of face-to-face interaction with pharmacists, prices that seem to rise without explanation, and pressure from the couple's CVS Caremark drug plan to use CVS stores instead of their local pharmacy. "They're not even a middleman," she said.
"They're a money grab for CVS." PBMs were conceived as a way to manage prescriptions and hold down costs. But these middlemen have become bipartisan punching bags, accused of sucking up profits at the expense of employers, governments, and patients. And while healthcare debates still divide Democrats and Republicans in Washington, D.C., taking on PBMs has become a unifying cause in an era of widespread frustration over rising healthcare costs.
In recent years, every state has imposed restrictions on PBMs. The Josephs' home state of Tennessee, where the GOP has a lock on state government, is among a growing number looking to outlaw companies that own PBMs from also owning brick-and-mortar pharmacies, as CVS does. That's aligned conservative, business-friendly Republicans with Democrats, who are traditionally more open to government regulation.
This legislative push reflects a feeling even in the GOP that the market for prescription drugs is being gamed, said Antonio Ciaccia, CEO of 46brooklyn Research, a nonprofit think tank that tracks drug pricing. "Republicans are looking at this issue, saying, We know what competition is supposed to do, and it isn't happening," said Ciaccia, a critic of the PBM industry. "This is not a free market." Charlie Joseph, a retired fire captain who now works as a custodian, was miffed when he realized he could save money on his blood pressure medication if he paid cash at his local pharmacy rather than using his CVS Caremark drug plan.
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