PBM Reform

Pharmacist backs Hawley’s PBM crackdown, says big insurers and their pharmacy benefit managers, not Big Pharma, are driving costs up and squeezing independent pharmacies.

PBM Audits

Audit of the Blue Cross Blue Shield Association's Service Plan's Retail and Mail Order Pharmacy Programs as Administered by CVS Caremark for Contract Years 2018-2021
Three findings from the report require corrective action: 1) A $478 million overcharge to the carrier and the FEHBP from not passing through negotiated discounts with two of the largest retail pharmacy chains, 2) Failing to return $108 million in credits for transmission fees collected from retail pharmacies to process the carrier's prescription drug benefits, and 3) An overcharge to the carrier of $27 million by paying the PBM an incentive above the retail claims pricing guarantee between the carrier and the PBM.