Drug Overcharges Resource Center
Who is responsible for exorbitant drug costs? The Defendants in these cases are both manufacturers of overpriced drugs and Pharmacy Benefit Managers (“PBMs”). PBMs are insurance industry gatekeepers who negotiate drug prices and create drug formularies that determine how much patients pay. The three largest PBMs that control 80% of health plan related drug purchases are CVS Health (aka “Caremark”), Express Scripts, and OptumRx. The PBMs have the power to drive down costs since drug companies must gain access to the PBM formularies to sell their drugs. Yet, instead, the PBMs and the drug manufacturers are gaming the system in order to maximize their profits. Drug companies buy access to the PBM formularies by paying “rebates” and other “fees” to the PBMs—and the PBMs chose which drugs to offer among competing products in large part based on who will pay the biggest “rebate.” This scheme drives up drug prices for consumers because the drug companies keep raising prices in order to pay larger and larger “rebates” and other “fees” to the PBMs, as well as to line their own pockets. Below are different areas of litigation and investigations related to the pharmaceutical industry. Please take a look and see if you have suffered from any of these abuses.