![]() (*The star ratings are calculated from verified ConsumerAffairs reviews submitted about CVS Caremark, Express Scripts, and OptumRx from March 1, 2021, through June 1, 2021.)Ĭustomers posting reviews at ConsumerAffairs found a lot to complain about with the big three PBMs. But reviews submitted between March 1, 2021, and June 1, 2021, show that complaints about PBMs have shot through the roof. In the past, CVS Caremark, Express Scripts, and OptumRx have generated some positive reviews at ConsumerAffairs. PBM complaints spike higherĬonsumer sentiment towards PBMs has historically been positive. The researchers said that produced an estimated $135 million in extra revenue for PBMs. It highlighted a University of Southern California study showing that the amount consumers co-pay for their drugs is above the rates reimbursed to pharmacies 25% of the time. In 2018, PBS produced an in-depth exposé on the practice of overcharging for prescriptions. However, many lawsuits have claimed that these companies have shown a “reckless disregard” for the rights of their members. ![]() In many ways, PBMs can have a positive impact on consumers because they have the power to control prescription drug prices so that they are more affordable. A staggering 266 million Americans (about 81% of the total population) are connected to PBMs in one way or another - either through commercial health plans, self-insured employer plans, union plans, Medicare Part D plans, the Federal Employees Health Benefits Program, state government employee plans, or managed Medicaid plans. Most consumers might not think that PBMs play a large role in their lives, but they do. PBMs play a large role in consumers’ lives Walmart likes what it sees so much that it has also decided to join up with a PBM to enhance its prescription business. In 2020, OptumRx reported annual revenue of close to $87 billion by handling more than a billion prescriptions full-year revenue at Evernorth, Express Script’s parent company, was reportedly over $116 billion. When Congress created the Medicare prescription drug benefit - aka Medicare Part D - and specified that it must be managed by private-sector prescription drug insurance providers, the doors of opportunity swung open even wider for PBMs. Express Scripts is owned by Cigna, CVS Caremark is owned by CVS Health (which owns Aetna), and OptumRx is owned by UnitedHealth Group (which owns UnitedHealthcare). The top three PBMs - Express Scripts, CVS Caremark, and OptumRx - control more than 70% of the marketplace. Photo (c) OwakiKulla - Getty ImagesAs Congress has made changes to the health care system over the past 30 years, nothing has impacted consumers' lives as much as the growth of pharmacy benefit managers (PBMs).
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