Dive Transient:
- The highest foyer for pharmacy profit managers has named Adam Kautzner, the pinnacle of main PBM Specific Scripts, as chair of its board.
- As board chair, Kautzner will oversee the Pharmaceutical Care Administration Affiliation’s technique, together with protection of the drug middlemen amid rising scrutiny of their position in rising drug prices.
- The PCMA has additionally created a brand new council to symbolize its mid-market purchasers, a phase of its membership that’s been rising, the foyer stated Tuesday. The council shall be represented by a brand new seat on the PCMA’s board to be held by Jeff Park, president of drug pricing platform Waltz Well being.
Dive Perception:
Kautzner is president of Cigna-owned Specific Scripts, the most important PBM within the U.S. overseeing pharmacy advantages for greater than 118 million individuals final yr. Kautzner can also be president of care administration for Cigna’s well being companies division.
Now, the chief is stepping up as board chair of PCMA, an influential affiliation that represents the three largest PBMs within the nation, Specific Scripts, CVS’ Caremark and UnitedHealth’s Optum Rx; vertically built-in PBMs owned by Humana and Elevance; and different pharmacy advantages firms.
A spokesperson for PCMA declined to touch upon Kautzner’s choice as board chair. However the government’s roles at Cigna have given Kautzner a “deep understanding of the dynamic advantages setting,” the PCMA stated in a launch.
It’s a tough time to be tasked with PBM protection. The businesses sit between insurers, drugmakers and pharmacies within the U.S. provide chain — negotiating reductions with drugmakers, controlling the position of medicines on plans’ formularies and reimbursing pharmacies for shelling out medication to their members.
PBMs say that place offers them distinctive leverage to manage rising drug prices. However critics are much less positive, pointing to PBM rebating practices that curtail entry and will even inflate the checklist price of medication, together with proof that payer purchasers and sufferers will not be benefiting from the financial savings that PBMs negotiate.
PBMs have additionally come underneath fireplace for allegedly strong-arming unbiased pharmacies into signing dangerous contracts. In the meantime, antitrust regulators are involved about market focus. Taken collectively, Specific Scripts, Caremark and Optum Rx course of roughly 80% of all U.S. prescriptions.
The PCMA’s job — to counter this narrative — has gotten tougher previously few years, given dogged curiosity on Capitol Hill round PBM reform. Together with launching advert campaigns blaming drugmakers for top drug costs and funding analysis discovering PBMs create worth for American sufferers, the PCMA additionally argues that the PBM market is aggressive regardless of the so-called “Massive Three.”
The PCMA’s creation of a brand new “affiliate council” to symbolize its mid-market members, together with Park’s appointment to the its new board seat, is “indicative of a various and aggressive PBM market,” a spokesperson for the foyer advised Healthcare Dive.
The PCMA spent greater than $17.5 million in 2024 on lobbying, up 14% from the prior yr, based on political transparency nonprofit OpenSecrets.
Within the first seven months of 2025, the PCMA spent virtually as a lot on lobbying because it did in your complete yr in 2022.
Although Congress did not go bipartisan laws overhauling PBM practices late final yr, momentum has carried into 2025. Legislators have issued a variety of payments meant to forestall the drug middlemen from profiteering off of their position within the pharmaceutical provide chain.
Nonetheless, PBM reform has fallen by the wayside amid pitched well being coverage battles over Medicaid cuts and the way forward for Reasonably priced Care Act subsidies, to call simply two. Congressional watchers don’t count on motion on the problem in 2025.
