Overview
- The Break Up Big Medicine Act would bar a parent company from owning a medical provider or management services organization alongside a PBM or a health insurer, and it would also restrict wholesaler–provider ties.
- Companies found in violation would have one year to comply, with enforcement actions open to the FTC, HHS, DOJ, state attorneys general, and private plaintiffs.
- The push follows new federal measures enacted last week that expand PBM transparency and shift Medicare Part D PBM compensation toward flat service fees.
- PBM concentration is a central target, with CVS Caremark, Express Scripts, and Optum Rx processing about 80% of U.S. prescriptions.
- States are moving on related fronts, as Arkansas’ restriction on pharmacy permits for PBM-affiliated entities faces a court challenge and similar proposals surface in Arizona, New Jersey, New York, and Pennsylvania.