Pharmacy benefit managers were paid by drugmakers, including Purdue Pharma, to keep opioid prescriptions flowing even as overdose deaths soared across the U.S., according to an investigation by The New York Times.
The Dec. 17 report highlighted how Express Scripts, CVS Caremark and Optum Rx, which control access to medications for millions of Americans, negotiated deals with opioid manufacturers to prevent restrictions on painkiller prescriptions in exchange for lucrative rebates.
Between 2003 and 2012, Purdue Pharma paid PBMs roughly $400 million annually to avoid limits on opioid prescriptions, which included measures that could have curtailed overprescribing, such as requiring additional physician justifications or limiting the number of pills dispensed.
Internal documents reviewed by the Times show how the PBMs repeatedly collaborated with opioid manufacturers to influence insurers' decisions and block restrictions.
As the opioid epidemic escalated, these companies continued to profit from the crisis. For instance, in 2012, Purdue agreed to increase rebates to Optum Rx to maintain access to OxyContin despite mounting safety concerns, the report said.
While public health campaigns and federal regulations began to impose tighter restrictions on opioids, the PBMs were slow to act, beginning to introduce safety measures in 2017 and 2018, and only after significant public pressure, according to the report.