News Briefs: Blue Shield of California Says PBM Unbundling ‘Won’t Always Mean’ Lower Prices
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Feb 27, 2025
Some Blue Shield of California says members may not see lower drug prices in the near term under its new unbundled pharmacy care program. The insurer moved away from a single PBM approach to contract with five companies to manage various aspects of pharmacy care in an effort to create more transparency and save money for enrollees in the long run. Matt Gibbs, Blue Shield of California’s chief pharmacy officer, wrote in a Feb. 19 article that the model “won’t always mean lower prices for each specific prescription drug, at least not immediately.” The model will allow employers and members to “gain true insight” into the cost of medications and “make informed decisions in their best interests,” he wrote. But some members might see cost increases for specific medications. “A medication that once cost $1-2, for example, may now be $10-15,” Gibbs wrote. “The reality is, that medication was never truly $1 to begin with.”
The Federal Trade Commission’s (FTC) lawsuit against the “Big Three” PBMs can move forward, a federal judge ruled. The PBMs — CVS Health Corp.’s Caremark, The Cigna Group’s Express Scripts and UnitedHealth Group’s Optum Rx — asked the court to halt the FTC’s lawsuit, claiming that it was unconstitutional. Judge Matthew Schelp of the U.S. District Court for the Eastern District of Missouri ruled that the case could proceed, stating insufficient evidence warranting an injunction at this time and that it would be “against the public’s interest.” The PBMs have appealed the ruling to the 8th Circuit Court of Appeals.
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