In modern American healthcare, the bridge between a physician’s prescription pad and a patient’s pharmacy is no longer a direct path. It's a toll road, governed by Pharmacy Benefit Managers (PBMs). Designed to streamline drug delivery and negotiate lower prices, the reality in 2026 is far more dangerous. When they deny specific therapy or life-altering drugs, they aren’t just managing a formulary; they're actively undermining a patient’s life.
We must first look at the absurd scale of market dominance. A staggering 79% of Rx claims in the U.S. are controlled by 3 entities: CVS Caremark (33%), Express Scripts (24%), and OptumRx (22%). When you expand to the top 6, it's 96%. This extreme concentration has led to limited competition, prompting FTC investigations.
The core issue is same as it always is with large concentrations of wealth or power. PBMs keep a % of rebates, so they often prefer expensive drugs that generate larger “kickbacks” over lower-cost alternatives that'd save patients money. And guess who gets screwed? Right, the patient...
Please watch the video on concentration of predatory wealth and power and read the rest of the piece at BAM!
