Amid Challenges, an Opportunity for PBMs To Do Business Differently, Says PCMA Leader | AMCP Annual 2025

Pharmacy benefit managers (PBMs) face a variety of challenges and must balance increasing pressure from markets, consumers and an evolving policy landscape, Juan Carlos Scott, president and CEO of the Pharmaceutical Care Management Association (PCMA), said at the Academy of Managed Care Pharmacy annual meeting today in Houston.

“The combination of increasing cost, demand and political activity creates an environment that's really ripe for disruption and change and also opportunity to think about how we do the business of PBM differently,” Scott said.

Juan Carlos Scott

PCMA is the trade association for the established PBM industry, which has come under sharp, bipartisan criticism from lawmakers and drawn the scrutiny of antitrust regulators. Scott and PCMA have countered with a narrative that PBMs use their bargaining power to rein in prices set by drug companies, benefiting benefit employers, other payers and patients in the process. Scott returned to some of those same arguments today. He cited recent data from Reuters that said the median annual launch price of a drug was about $300,000 in 2023, with plans to increase the price of 250 drugs this January.

“America's patients are facing an affordability challenge,” Scott said. “It's exacerbating the pressure that inflation put on other essentials like groceries and housing."

Scott said that this is where PBMs come in, negotiating with drug companies to secure savings. He said that PBMs save, on average, $1,154 per person per year and provide access to drugs to 289 million people in the U.S. He said that it’s essential to focus on biosimilars, GLP-1s, information transparency, pharmacy innovation and lowering out-of-pocket costs, specifically by introducing more competitors into the market and offering programs that combine GLP-1 coverage with patient support for lifestyle changes through diet and exercise.

Scott's fellow panelist, Mariss Schlaifer, RPh, M.S., vice president of policy at Optum, said PBMs need to respond to the pressures being put upon them.

“Whether it's patients, providers, our pharmacies or our clients, everyone is demanding — and rightfully demanding — that PBMs do more to make this whole process easier to navigate, more affordable and more accessible,” she said.

Marissa Schlaifer, RPh, M.S.

Optum Rx, one of the three largest PBMs in the country, is part of Optum, which is the health services arm of UnitedHealth Group. According to Schlaider, some of the ways that Optum has responded include implementation of "My Script Finder," which compares drug prices at various locations, and Optum Savings IQ, which automatically aggregates financial assistance opportunities. She said that by Jan. 1, 2028, OptumRx will be passing through 100% of its rebates to its clients. PBMs have been criticized for taking advantage of their position as middlemen in the drug supply chain to pocket as profits the money they collect as rebates from drugmakers.

“The [PBM] industry is moving to meet the moment so that we can continue to do our work for clients and for patients,” Scott said. “Everybody has to be at the table in the supply chain. We need to be working together.”