Congressional scrutiny aside, ‘the rebate model remains alive and well’ as the big three pharmacy benefit managers exclude around 600 drugs each from their formularies.

As health insurance lobby launches advertising campaign to defend ‘evidence-based, market-driven tools,’ drug firms point out the connection between insurers and pharmacy benefit managers.

When the sector worries about regulation it is usually about drug development and registration. But governments also regulate on monopolistic positions in life sciences. Adding to that, national security enforcement is now rising.

According to a report commissioned by PhRMA, the three largest pharmacy benefit managers continue to exclude more drugs from standard formularies, including those with expedited FDA approval.