If you’re unfamiliar with the term, you might think “pharmacy benefit manager” is a job title for some anonymous mid-level health insurance executive. Like, say, the guy pictured above. But no, a pharmacy benefit manager is a corporation that sticks its big fat nose into the middle of America’s misbegotten prescription drug system and snorts up all the loose cash it can.

That’s my definition anyway. If you’re a high-priced lobbyist for the national PBM trade association, things look a little different. “Pharmacy benefit managers exist for one purpose: to drive down cost of prescription drugs,” said Sam Hallemeier of the Pharmaceutical Care Management Association (PCMA). PBMs, he continued, “reduce costs for insurers and consumers, reduce waste, and improve patient care.”

Wow, I hadn’t realized that PBMs are charitable enterprises that simply want to make the world a better place.

Oh wait, they’re not. The PBM marketplace is dominated by three large firms that are owned by three of America’s largest for-profit health care firms: Caremark, operated by drugstore chain CVS; Express Scripts, operated by insurance giant Cigna; and OptumRx, brought to you by insurance giant (and sworn foe of spaces between words) UnitedHealth. These mega-corporations are in business to make profits. If their PBMs are holding down costs, you can bet your life they’re doing it for their own benefit, not yours or mine.

You may wonder when I’m going to get to the Vermont political point of this. Well, the Legislature is considering a bill, H.233, that would impose substantial new restrictions on PBMs. And while our state has a track record of disappointment when it comes to health care, this thing might actually stick.

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