Meeting at the Crossroads: The Role and Impact of PBMs and BOPs on Pharmacists

From the pharmacy industry’s common understanding of pharmacy benefit managers (PBMs) to the legal challenges that often surround them, advanced knowledge of PBMs and their place in the drug supply chain can be crucial for pharmacy businesses. Furthermore, using each respective practice’s state board of pharmacy as a resource, community pharmacies all across the nation have the ability to manage challenging PBM relationships.

“On paper, PBMs are the middlemen between the employers and the pharmacies who dispense prescription drugs to patients or enrollees of the employer's health benefit plan or prescription drug benefit plan,” said Dae Lee, PharmD, Esq, CPBS, shareholder at Buchanan Ingersoll & Rooney. “There are only 3 PBMs in the country that administer or manage 80% of the entire country's prescription drug claims, and these are CVS Caremark, Optum Rx, and Express Scripts. These PBMs are vertically integrated, and vertical integration has become a culprit of the ever-increasing drug spend premium and out-of-pocket costs.”

Along with his colleague, Lucas Morgan, Esq, also a shareholder at Buchanan Ingersoll & Rooney, the pair hosted a presentation at the Total Pharmacy Solutions Summit Winter 2025 virtual event titled, “Meeting at the Crossroads: The Role and Impact of PBMs and BOPs on Pharmacists.”

Statistics surrounding the top 3 PBMs’ market share have been available for a few years and have become significantly well-known across the pharmacy industry and beyond. However, aside from the vertical integration, spread-pricing, and other tactics PBMs have dwelled upon, there are other legal approaches they’ve taken that pharmacy businesses have struggled to manage.

In their presentation, Lee and Morgan discussed their experience in legal deliberations involving PBMs. They also explained the role of state boards of pharmacy and how they can serve as a resource for any potential PBM-related hurdles.

With pharmacies being the medication and patient-care experts, their focus on PBM control and navigating it can sometimes fall to the wayside. Learn from representatives of Buchanan Ingersoll & Rooney about how PBMs operate in the legal space and where pharmacies tend to fall within it all.

Explore more of our coverage from the Total Pharmacy Solutions Summit Winter 2025: Advocacy in Motion.