Patients Not PBMs is a coalition of Massachusetts organizations that has formed to raise awareness around how pharmacy benefit managers (PBMs), or "middlemen," are putting profits before consumers' healthcare. The coalition’s focus is to educate consumers about PBMs, and to advocate for policy actions in Massachusetts that will prevent PBMs from continuing to drive up the price of prescription drugs by taking savings away that should be passed along to consumers.

PBMs are a major driver behind the high cost of prescription drugs. Acting as middlemen, PBMs use their consolidated market power to steer patients toward affiliated or preferred retail pharmacies. Over the past decade, PBMs have implemented narrow networks that incentivize or require patients to fill prescriptions at specific pharmacies that are either affiliated with the PBM or that agree to accept lower reimbursement rebates as a condition of network participation. Unfortunately, this does not mean the cost of patients’ prescriptions are lower at the preferred pharmacy; in some cases, the cash price at competing pharmacies is significantly lower than the insured price at preferred pharmacies.

Five of the six biggest PBMs are part of large, vertically integrated organizations. There is significant ownership overlap between PBMs, health insurers, specialty and mail-order pharmacies and provider organizations. Today’s “big three” PBMs – Express Scripts, CVS Caremark, and OptumRx — control over 80 percent of the market, covering roughly 180 million prescription drug customers, and are grabbing tens of billions of dollars in rebates and discounts on medicines that should be passed on to consumers.