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PBMs and Vertical Integration: CBO Adds To Growing Concerns About Negative Impacts

 
• By Sarah Karlin-Smith

Congressional Budget Office responses to questions from US lawmakers on pharmacy benefit managers could add to the momentum for PBM reforms to go further than the current leading proposals.

CBO suggests downsides to vertical integration between PBMs and health insurance companies. • Source: Shutterstock

The Congressional Budget Office raised concerns about the potential harms of joint ownership of pharmacy benefits managers, health insurance companies and pharmacies in new responses to US lawmaker questions, adding to the chorus of scrutiny that may be building toward 2025 Congressional action against vertical integration in the health sector.

Key Takeaways

  • CBO says savings on drug prices generated from insurance-PBM mergers may not be getting to patients.

  • Meanwhile, nonintegrated health plans see increased drug costs due to PBM-insurance integration

Insurance company and PBM mergers “tends to lower the prices paid for drugs” and “reduce spending on drugs for patients in vertically integrated health insurance plans,” the CBO found, but any reductions in spending by

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