Potential Big Impact If Firms That Own Pharmacy Benefit Managers Must Break Up

InnovationHealthcarePotential Big Impact If Firms That Own Pharmacy Benefit Managers Must Break UpByJoshua P. Cohen,Senior Contributor.Forbes contributors publish independent expert analyses and insights. Joshua Cohen is a Boston-based writer who covers health policy.Follow AuthorJun 01, 2026, 01:04pm EDT--:-- / --:--This voice experience is generated by AI. Learn more.This voice experience is generated by AI. Learn more.FEB. 4, 2026: Rep. Buddy Carter, R-Ga., participates in a news conference in the U.S. Capitol on pharmacy benefit manager reforms included in the Consolidated Appropriations Act. (Bill Clark/CQ-Roll Call, Inc via Getty Images)CQ-Roll Call, Inc via Getty ImagesA bipartisan group of legislators reintroduced a proposal last month — the Patients Before Monopolies Act — that would prohibit healthcare companies that own pharmacy benefit managers from owning retail pharmacies. If the bill passes, companies will have one year to sell their pharmacies. This proposed legislation constitutes a much greater threat to profitability in the health insurance industry than the set of PBM reforms that have moved forward thus far.Vertically integrated conglomerates such as Cigna, CVS Health and UnitedHealth, control multiple parts of the prescription drug supply chain, from pharmacies and health insurers to the “Big Three” pharmacy benefit managers — Express Scripts, CVS Caremark and OptumRx, respectively.Over the years PBMs have invariably found ways to offset diminished sources of revenue and generate new ones. They will likely continue to do so, particularly since the entities they’re part of have been left intact by the latest reform measures. But the proposed bill would break apart the vertically integrated organizations and target retail pharmacies, including specialty units, one of the industry’s major profit engines. Specialty pharmacies focus on dispensing and managing high-cost, high-complexity medications for patients with serious, chronic or rare health co...