United States targets PBM transparency to address drug costs and pharmacy deserts

The Trump administration is preparing a Labor Department regulation aimed at increasing transparency within pharmacy benefit managers (PBMs). Expected to take effect in July, the rule will require PBMs to disclose detailed information regarding drug prices, manufacturer payments, and other revenue sources to self-insured employers. Key provisions include the disclosure of expected compensation from drugmakers and pharmacies, semi-annual reporting of actual earnings, and the ability for employers to audit PBM operations. The regulation also targets “spread pricing,” a practice where PBMs retain the difference between what an employer pays for a medication and what the pharmacy receives.

Simultaneously, concerns are rising regarding the emergence of “pharmacy deserts” in the United States, particularly in underserved communities. Advocacy groups, including the University of Southern California and the National Community Pharmacists Association, have launched a Pharmacy Access Initiative to study how PBM practices may be driving independent pharmacies out of business. Critics argue that the three largest PBMs—Express Scripts (a Cigna subsidiary), OptumRx (owned by United Healthcare), and CVS (which owns Aetna)—control 80 percent of the U.S. prescription market and contribute to these access gaps by limiting independent pharmacies' ability to remain viable.