Curie Brief
Turn on cookies to sign in
Signing in saves your progress to your Curie account. We can only do that with cookies on — turn them on to continue.
News
A study in JAMA Health Forum reveals that pharmacy benefit managers (PBMs) may have helped drive the opioid crisis by striking financial deals with manufacturers that incentivized higher opioid prescribing. Internal documents show PBMs like Express Scripts and Medco coordinated with Purdue Pharma to promote OxyContin and expand coverage for higher doses — all while pocketing tens of millions in rebates.
A new study published in JAMA Health Forum shines a light on a largely undisclosed chapter of the opioid crisis: the role of pharmacy benefit managers (PBMs). Researchers from UCSF analyzed 23 internal industry documents spanning 1997 to 2018 and found that PBMs — the powerful middlemen between insurers and drug manufacturers — had financial arrangements with opioid makers that incentivized pushing more prescriptions at higher doses.
The documents reveal a troubling pattern: in 1999, Purdue Pharma coordinated with Express Scripts to send roughly 30,000 physician education emails and 22,500 pharmacy fax blasts promoting OxyContin. Meanwhile, Medco expanded coverage for higher opioid doses without requiring prior authorization, and received over $30 million in rebates from OxyContin sales in both 2001 and 2002 alone.
By the Numbers:
Why it matters: This study adds hard evidence to longstanding allegations that PBMs weren't just passive players in the opioid epidemic — they had financial skin in the game. Experts are now calling for greater transparency in PBM-manufacturer contracts and for financial incentives to be realigned with patient safety, particularly for high-risk, addictive medications.
