The Missouri Times: Prescription Drug Middlemen Undermine Patient Health, Increase Cost of Medicine

By Connie Farrow, Patients Come First Missouri Executive Director

Consumers, doctors and other advocates agree pharmacy benefit managers (PBMs) wield too much power and influence over patients’ access to medicines and their prices. Their efforts to reveal the lack of transparency and accountability in the pharmacy supply chain that benefits bad actors appears to be gaining traction among state and federal officials.

President Trump signed an executive order April 16 requiring the Secretary of Labor to propose regulations to improve transparency over PBM compensation. Trump wants to create a transparent, competitive and fair prescription drug market for American consumers.

PBMs receive deep discounts and rebates on medicines. Consumers are not privy to how much these middlemen receive, and therefore, it becomes much more difficult for patients to compare competing drug brands based on price.

The Federal Trade Commission has published two interim staff reports, detailing the negative consequences of the evolution of PBMs into vertically-integrated conglomerates that control every link in the drug coverage and delivery chain, including pharmacies and health plans. The latest 2025 report found the Big 3 PBMs – CVS Caremark, Express Scripts and Optum Rx – had generated over $7.3 billion in excess revenue by imposing markups of hundreds and thousands of percent on a wide range of lifesaving drugs between 2017-2022.

These markups can put critical medications out of reach for Missouri patients already facing limited access to care.

As patient advocates, we worry about vulnerable individuals who may have skipped dosages to save money or decided to forego life-saving treatment altogether because the inflated prices put medication out of reach.

Read the full LTE in The Missouri Times here.