Show-Me State Times

Connie Farrow, executive director of Patients Come First–Missouri, expressed concerns about pharmacy benefit managers (PBMs) in an opinion piece published in The Missouri Times. Farrow said that PBMs are undermining patient health by driving up the cost of medicine.

"Consumers, doctors and other advocates agree pharmacy benefit managers (PBMs) wield too much power and influence over patients' access to medicines and their prices," said Farrow. "The present role of PBMs in prescription drug markets is failing. It's time to rein in abuses in the PBM market to ensure patients have access to the affordable medicines and care they need in their community. As patient advocates, we worry about vulnerable individuals who may have skipped dosages to save money or decided to forego life-saving treatment altogether because the inflated prices put medication out of reach."

According to the Federal Trade Commission (FTC), PBMs have evolved into vertically integrated conglomerates, consolidating control over drug coverage and delivery, including pharmacies and health plans. This consolidation has reduced transparency and led to increased medication costs for consumers. The FTC's second interim staff report, released in 2025, highlights how the dominance of the largest PBMs has negatively impacted drug affordability and patient access.

The FTC reported that the three largest PBMs – CVS Caremark, Express Scripts, and Optum Rx – control approximately 80% of the prescription drug market in the United States. This dominance allows them to negotiate substantial rebates from manufacturers, but these savings are not consistently passed on to consumers. The report highlights concerns over how this market concentration affects drug pricing and patient access.

BRG reported that contract pharmacy arrangements under the 340B Drug Pricing Program have led to significant financial impacts on Medicaid. The report found that manufacturer mandates related to contract pharmacies have increased costs and diminished the savings intended for low-income patients. These practices have raised concerns about the efficient use of program resources and their impact on healthcare affordability.

According to her LinkedIn profile, Farrow is an award-winning journalist turned PR and advocacy consultant, specializing in strategic messaging, media relations, and public policy campaigns in healthcare, education, consumer goods, and pharmaceuticals.