Lavern Spicer, Founder and Executive Director of Curley’s House of Style, Inc./Hope Relief Food Bank, has called for Congress to implement strong transparency reforms concerning Pharmacy Benefit Managers (PBMs) and the 340B Drug Pricing Program. “PBM opacity is driving up costs and denying care,” — a matter gaining traction in Pennsylvania. Spicer made this statement on X, Nov 24.
“The three largest Pharmacy Benefit Managers control ~80% of the market,” said Spicer. “insurance giants and their PBM middlemen are cashing in hundreds of billions. PBM reform isn’t a partisan pipe dream – it’s the clearest, most achievable fix Congress can pass RIGHT NOW. Y’all in Washington keep talking about “affordability” but refuse to act.”
PBMs are currently under bipartisan scrutiny in Congress. Lawmakers are investigating opaque fees, rebate practices, and steering mechanisms that may contribute to increased patient costs. The Federal Trade Commission (FTC) is conducting an inquiry into pricing methods and reimbursement practices. Several bills have been proposed to enhance transparency and limit spread pricing. The three largest PBMs—CVS Caremark, Express Scripts, and OptumRx—dominate approximately 79% of the market.
The FTC’s second interim staff report released on January 14, 2025, highlights significant PBM markups on specialty generics used for conditions such as cancer and HIV. It describes how vertically integrated PBMs affect pricing and access through complex fee structures and affiliated pharmacy steering. These findings have reinforced calls to “shine a light” on hidden rebates and spread pricing that can increase costs for patients and payers.
The Pennsylvania Auditor General reported that taxpayers’ payments to PBMs for Medicaid enrollees doubled from $1.41 billion in 2013 to $2.86 billion in 2017, with three PBMs making between $2 million and $40 million on spread pricing—up to about $13 profit per Medicaid prescription—while some pharmacies were reimbursed hundreds of dollars below acquisition cost on individual claims.
Spicer founded Curley’s House of Style, Inc./Hope Relief Food Bank in August 2001 as a grassroots nonprofit organization serving low- to moderate-income families, seniors, at-risk youth, the homeless, veterans, and people with HIV/AIDS across Miami-Dade County. Her advocacy focuses on affordability and access to essential services.
