The nation's leading pharmacy benefit manager (PBM) lobbying group is mounting a major offensive, escalating its public relations and policy push against the pharmaceutical industry following last winter's congressional overhaul of PBM practices.
The Pharmaceutical Care Management Association (PCMA), representing the middlemen that negotiate drug prices for insurers, is rolling out a seven-figure advertising campaign—its largest ever—and a policy agenda focused on affordability and transparency from drugmakers. The move comes as lawmakers, eyeing the upcoming midterm elections, zero in on healthcare costs.
David Marin, who took the helm as PCMA's CEO in January, acknowledged in an interview that the industry had long operated in the shadows and failed to effectively communicate its role. “We want to be utterly transparent, we want to be fully understood,” Marin said. “We do not want to be opaque.” He conceded that the pharmaceutical industry had successfully scapegoated PBMs, making them a prime target for reform.
Marin, a former Viatris executive, said the industry spent too much time on defense. “I think it's safe to say that for too long we were in a defensive posture, and that's not what policymakers are looking for,” he said. “There was relentless energy from Big Pharma to shine a light on PBMs, and they were effective.”
The reforms, tucked into a government funding bill, impose new transparency reporting requirements, ban so-called spread pricing in commercial plans—where PBMs pocket the difference between what they charge insurers and reimburse pharmacies—and delink PBM compensation from drug list prices, removing a conflict of interest that could steer patients toward pricier medications.
PBMs, which manage prescription drug plans for insurers, negotiate rebates and discounts with manufacturers and determine patient access and costs. The three largest—UnitedHealth Group's Optum Rx, CVS Health's Caremark, and Cigna's Express Scripts—control roughly 80% of U.S. prescriptions. Critics have long argued their opaque practices inflate costs.
Now, PCMA aims to reframe the narrative. “We allowed others to define us, others who had a clear interest in diverting attention away from the role that they play in keeping drug prices too high for too long for too many, and they did it well,” Marin said. “So I tip my hat to them, but we have to change that dynamic.”
The lobbying push also seeks to head off additional reforms. Marin warned against piling on new regulations, especially during the post-election lame-duck period. He pointed to a pending Department of Labor transparency rule, calling it duplicative of Congress's work. “It's important that members sometimes be reminded of the massive reform package that they just passed,” he said. “I think it's only smart policy to allow those reforms some time to ripen and mature.”
The battle over drug pricing remains a partisan flashpoint. Senate Democrats have signaled they will pursue further PBM reforms if they retake control next year. Meanwhile, the pharmaceutical industry continues to face its own scrutiny, but after PBM regulation narrowly failed in 2024, drugmakers and their allies pressed hard for congressional action.
Similar dynamics are playing out in other policy arenas, such as the Blanche nomination testing rule of law amid bipartisan backlash and the federal judge blocking Trump's bid to create a national voter database, where legal and political battles continue to shape the landscape.
Marin said the new ads are “simple, focused on people, educational, and highlight the two foundational roles that PBMs play: lowering drug costs and protecting and promoting patient safety.” Whether that message will resonate with voters and lawmakers remains to be seen, but the PBM industry is clearly no longer content to stay in the shadows.
