New coalition seeks legislation to force transparency for PBMs

Hartford Business Journal – Thursday, January 9, 2025
By David Krechevsky

A coalition of patient advocacy groups, independent pharmacists and local business groups has formed a new organization to seek legislation to force transparency around pharmacy benefit managers (PBMs).

Calling itself Patients Not PBMs Connecticut, the Hartford-based group said it will push for bills in the state legislature to require PBMs to “be more transparent, stop keeping rebates intended for patients, stop interfering with patient access to needed care and reimburse pharmacies and physicians fairly.”

Coalition members include the Connecticut Association of Community Pharmacies, PhRMA, BioCT, Advancing Connecticut Together, the Michael J. Fox Foundation, U.S. Pain Foundation, Connecticut Oncology Association, Diabetes Patient Advocacy Coalition, ADAP Advocacy, PILMA, National Infusion Center Association, Rare New England, the Northeast Pharmacy Service Corp. and Infusion Access Foundation.

PBMs, are companies hired to manage prescription drug benefits for health insurers, Medicare Part D drug plans, large employers, and other payers. They negotiate with drug manufacturers and pharmacies to control the cost of medications.

Three major PBMs — Express Scripts, CVS Caremark, and OptumRx — make up 75% of the market.

“Pharmacy Benefit Managers were originally designed to help reduce prescription drug costs, but instead, they have become a barrier between patients and the care and savings they deserve,” said Dawn Holcombe, executive director of the Connecticut Oncology Association. “Patients Not PBMs Connecticut is committed to demanding greater transparency and fairness from PBMs, ensuring that rebate dollars go where they belong — into the hands of patients without interference or needless delays.”

The announcement of the new coalition comes the day after the state General Assembly convened its 2025 legislative session, which ends on June 4.

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