IN SUMMARY: PBMs are keeping a smaller share of rebates and passing more along to their clients. Instead, PBMs are collecting more revenue through various fees — the same shift the Trump administration envisions — and through a practice called “spread pricing,” according to a Pew analysis.

  • PBMs often portray themselves as fighting the “good fight” on behalf of employers and employees.
  • In reality, they are highly profitable intermediaries that typically do not take possession of the drug, bear little to no risk, and minimally innovate.
  • PBM profit margins are much higher than other players in the supply chain who bear much of the public’s anger over rising drug prices.
  • Express Scripts for example, one of the largest PBMs, reported gross profits of $8.76 billion in 2017.