State Attorneys General Investigate PBM Influence Over Health Plans Amid Concerns of Self-Benefit
State Attorneys General are expressing concerns regarding potential conflicts of interest within the pharmacy benefit manager (PBM) industry. These concerns center on the influence PBMs may exert over health plan designs and the resulting impact on the distribution and pricing of prescription medications. Specifically, the Attorneys General are scrutinizing business practices that could allow PBMs to prioritize their own financial interests. This raises questions about whether PBMs may be structuring health plan formularies and negotiating drug prices in ways that benefit themselves, potentially at the expense of patients and independent pharmacies. The AGs are focusing on whether this dominance distorts the market and reduces competition, leading to higher costs and limited choices for consumers.
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Date: April 15, 2025