---
title: "Insurers fight proposals to force them to sell their pharmacy middlemen"
description: "The country's largest health insurers are pushing back against proposals in Washington and beyond that would force them to break off the pharmacy benefit managers they own, the powerful middlemen that sit between drugmakers, pharmacies and patients. The companies say the arrangement lowers costs; critics say it inflates drug prices and squeezes independent pharmacies."
category: "U.S."
category_url: https://herald.la/category/us
author: "Omar Haddad"
published: 2026-07-08T13:56:00.000Z
updated: 2026-07-08T13:56:00.000Z
canonical: https://herald.la/article/insurers-fight-proposals-to-force-them-to-sell-their-pharmacy-middlemen
tags: ["health-insurance", "pharmacy-benefit-managers", "drug-prices", "congress", "ftc"]
---
# Insurers fight proposals to force them to sell their pharmacy middlemen

The country's largest health insurers are pushing back against proposals in Washington and beyond that would force them to break off the pharmacy benefit managers they own, the powerful middlemen that sit between drugmakers, pharmacies and patients. The companies say the arrangement lowers costs; critics say it inflates drug prices and squeezes independent pharmacies.

At the center of a fight over drug prices sits a business most Americans have never heard of: the pharmacy benefit manager. Now the insurers that own the biggest ones are working to head off proposals that would force them to let go.

## What is being proposed

Some lawmakers want to require companies that own both a health insurer and a pharmacy benefit manager, or P.B.M., to sell one of them off. A bipartisan bill from Senators Elizabeth Warren, a Massachusetts Democrat, and Josh Hawley, a Missouri Republican, would compel such divestitures, [Modern Healthcare reported](https://www.modernhealthcare.com/politics-policy/pbm-act-cvs-unitedhealth-cigna-elizabeth-warren-josh-hawley/). Separately, the Federal Trade Commission has pursued the industry, reaching settlements with the three largest P.B.M.s over insulin pricing, [BenefitsPRO reported](https://www.benefitspro.com/amp/2026/06/16/optum-rx-becomes-final-pbm-to-reach-settlement-with-ftc-over-insulin-pricing/).

The targets are the so-called Big Three: Optum Rx, owned by UnitedHealth Group; Caremark, owned by CVS Health; and Express Scripts, owned by Cigna. Together they manage roughly 80 percent of U.S. prescriptions, [according to KFF](https://www.kff.org/other-health/what-to-know-about-pharmacy-benefit-managers-pbms-and-federal-efforts-at-regulation/).

## The case for a breakup

P.B.M.s negotiate drug prices and decide which medicines insurance will cover and on what terms. Critics argue that when the same company owns the insurer, the P.B.M. and often a pharmacy chain, it creates conflicts of interest, steering patients to its own pharmacies while paying independent competitors less. Senator Warren has said the middlemen "manipulated the market to enrich themselves, hiking up drug costs, cheating employers, and driving small pharmacies out of business," [Healthcare Dive reported](https://www.healthcaredive.com/news/pbm-act-force-pharmacy-sales-introduced-unitedhealth-cigna-cvs/735233/).

## The industry's defense

The companies and their trade group say the integrated model benefits patients. A representative of the Pharmaceutical Care Management Association argued that the industry's "value is in helping patients conveniently, safely, and affordably access prescription drugs," [Healthcare Dive reported](https://www.healthcaredive.com/news/pbm-act-force-pharmacy-sales-introduced-unitedhealth-cigna-cvs/735233/). Industry backers contend that combining functions can lower costs and that a forced breakup would not necessarily produce savings.

Beyond argument, the companies are fighting on other fronts, through lobbying and in court; one of the P.B.M.s has sued to block a tough state P.B.M. law in California, [The American Prospect reported](https://prospect.org/2026/06/11/threat-of-big-insurance-lobbying-congress-donations/).

## Where it stands

For all the attention, a forced breakup faces long odds. Analysts have described the chances of the divestiture legislation passing as slim, and Congress has so far leaned toward transparency requirements rather than structural separation, [MedCity News reported](https://medcitynews.com/2026/03/congress-pbm-vertical-integration/). That leaves the core question, whether the companies that both insure patients and manage their drug benefits should be allowed to do both, unresolved, and the subject of a fight that the industry, for now, is winning.