Amye Joseph says America\u2019s political polarization has made it an \u201cinteresting time\u201d in her Tennessee household. She and her husband, Charlie, have been married 35 years. She\u2019s a Republican. He\u2019s a Democrat.<\/p>\n
But their shared disenchantment with profit-driven healthcare has provided a unifying target: pharmacy benefit managers, known as PBMs. The Josephs\u2019 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\u2019s dominant PBMs (CVS Caremark), and America\u2019s largest retail pharmacy chain.<\/p>\n
\u201cWe hate CVS. I\u2019m going to be straight-up,\u201d Amye Joseph said.<\/p>\n
She laments the lack of face-to-face interaction with pharmacists, prices that seem to rise without explanation, and pressure from the couple\u2019s CVS Caremark drug plan to use CVS stores instead of their local pharmacy. \u201cThey\u2019re not even a middleman,\u201d she said. \u201cThey\u2019re a money grab for CVS.\u201d<\/p>\n
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.<\/p>\n
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.<\/p>\n
In recent years, every state has imposed restrictions on PBMs. The Josephs\u2019 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.<\/p>\n
That\u2019s aligned conservative, business-friendly Republicans with Democrats traditionally more open to government regulation.<\/p>\n
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>, a nonprofit think tank that tracks drug pricing.<\/p>\n \u201cRepublicans are looking at this issue, saying, We know what competition is supposed to do, and it isn\u2019t happening,<\/em>\u201d said Ciaccia, a critic of the PBM industry. \u201cThis is not a free market.\u201d<\/p>\n 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. He now buys a 90-day supply for the same price he would have paid for a 30-day supply through the CVS plan.<\/p>\n The Josephs don\u2019t like dealing with pharmacy benefit managers. PBMs, designed as intermediaries between drugmakers and insurance companies to negotiate drug prices, have become targets of bipartisan anger over health costs. (Earl Neikirk for KFF Health News)<\/p>\n \u201cRight now, it\u2019s more of an inconvenience than anything else as far as it goes, but there\u2019s no consistency,\u201d he said. \u201cThe whole healthcare thing is just frustrating, on a good day.\u201d<\/p>\n CVS spokesperson Phil Blando said the price of individual drugs can vary.<\/p>\n \u201cLooking at the price of a single prescription does not reflect the value of a comprehensive pharmacy benefit,\u201d he said in a statement. \u201cOur focus remains delivering the lowest possible total cost and the greatest overall value for members and plan sponsors.\u201d<\/p>\n Unified Opposition<\/strong><\/p>\n PBM officials say their industry has been unfairly maligned. \u201cPBMs are the only part of the prescription drug supply chain working to lower drug costs, which makes PBMs the target of powerful groups, Big Pharma and pharmacists,\u201d said Greg Lopes, a spokesperson for the Pharmaceutical Care Management Association, which represents PBMs across the nation.<\/p>\n \u201cDrug manufacturers attempt to shift blame for high drug costs to PBMs in order to retain their profit margins and weaken PBMs\u2019 ability to lower costs,\u201d he said.<\/p>\n Drugmakers have worked for years to cast PBMs as unnecessary go-betweens, said Barak Richman, a lawyer and economist who studies healthcare competition at George Washington University. He called the fight between the two industries a corporate \u201ccage match.\u201d<\/p>\n \u201cWe have wildly passionate partisan divides on a lot of healthcare,\u201d he said. \u201cBut there\u2019s a lot of healthcare policy that I don\u2019t think is obviously partisan.\u201d<\/p>\n PBMs haven\u2019t won over many Democrats or Republicans. Attorneys general from nearly 40 states and U.S. territories wrote a letter<\/a> last year to congressional leaders arguing that \u201chorizontal consolidation and vertical integration have transformed PBMs from useful administrative service providers into market-dominating behemoths.\u201d<\/p>\n In state legislatures like Tennessee\u2019s, shared ownership of PBMs and pharmacies has drawn particular fire. Independent pharmacies have little choice but to contract with major PBMs while also competing with the conglomerate-owned pharmacies. Many lawmakers have said they want to protect small businesses.<\/p>\n \u201cIf a corporation argues that its pharmacy cannot survive unless it is owned by the same entity that sets the reimbursement rate, then we\u2019re not talking about a free market. We\u2019re talking about control,\u201d Tennessee state Sen. Bobby Harshbarger said in a February legislative hearing.<\/p>\n Harshbarger, a Republican who led the legislative push, is a pharmacist in a small city in northeastern Tennessee.<\/p>\n His mother, U.S. Rep. Diana Harshbarger (R-Tenn.), is also a pharmacist and has sponsored a similar PBM ownership ban at the federal level<\/a>. The Senate version has brought together some unlikely bedfellows, such as Sens. Elizabeth Warren (D-Mass.) and Josh Hawley (R-Mo.).<\/p>\n State Lawmakers vs. CVS<\/strong><\/p>\n CVS officials argued the Tennessee legislation was misguided. \u201cAny proposed reform should be evaluated based on whether it improves access to care, simplifies the patient experience, and enhances affordability,\u201d Blando said.<\/p>\n It\u2019s unclear whether the PBM ownership ban will do that in Tennessee. An analysis<\/a> by the state legislature\u2019s researchers concluded that the bill could drive up healthcare costs in the short term.<\/p>\n To fight the bill, CVS launched a $7 million TV advertising campaign<\/a>, claiming it would have to close all its 134 pharmacies in the state, similar to its threat in neighboring Arkansas when state lawmakers there passed a similar measure<\/a> in 2025.<\/p>\n CVS also sent text messages<\/a> to Tennessee customers, asking them to contact their lawmakers to keep pharmacies open. Ominous texts<\/a> from CVS helped kill a PBM ownership ban in Louisiana last year.<\/p>\n Sponsors of the legislation said closure wasn\u2019t the only option: CVS could also divest either its stores or its PBM.<\/p>\n Tennessee lawmakers moved forward. State Sen. Rusty Crowe, a Republican from northeastern Tennessee, where the Josephs live, told his colleagues before the vote that they should consider the fierce resistance a sign that they were onto something.<\/p>\n \u201cI learned when I was in the Vietnam War, when you start taking on flak, you know you\u2019re over the damn target,\u201d he said.<\/p>\n As with most votes in Tennessee\u2019s legislature, Republicans didn\u2019t need support from Democrats. But they got it anyway.<\/p>\n State Rep. Antonio Parkinson, a Democrat from Memphis, said he felt like he was voting in favor of lower drug prices and supporting \u201cma and pa\u201d pharmacies. \u201cIf there\u2019s a benefit to my people, I\u2019m supporting it.\u201d<\/p>\n CVS has not divested or closed its pharmacies in states that have passed ownership bans \u2014 the laws have yet to take effect. The Arkansas ban is being held up in court after CVS challenged the constitutionality of the law. CVS also sued in Tennessee, though the ownership ban doesn\u2019t take effect until 2028.<\/p>\n This article is from a partnership that includes <\/em>Nashville Public Radio<\/em><\/a>, <\/em>NPR<\/em><\/a>, and KFF Health News.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" Amye Joseph says America\u2019s political polarization has made it an \u201cinteresting time\u201d in her Tennessee household. She and her husband, Charlie, have been married 35 years. She\u2019s a Republican. He\u2019s a Democrat. But their shared disenchantment with profit-driven healthcare has provided a unifying target: pharmacy benefit managers, known as PBMs. The Josephs\u2019 frustration is focused…<\/p>\n","protected":false},"author":0,"featured_media":15745,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-15744","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/15744"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=15744"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/15744\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/15745"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=15744"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=15744"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=15744"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}