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1) Government pressure: Health and Human Services Secretary Alex Azar and Food and Drug Administration Commissioner Scott Gottlieb, MD, have each delivered incisive speeches with strong words directed at health plans and PBMs, criticizing a lack of transparency around their drug pricing and rebating contracts.
Tyrone's Commentary: The winds of change have begun to blow.
2) Industry pressure: While PBMs are pushed by the government on one front, they're fighting a second front with private industry, enduring criticism from the pharmaceutical industry and a series of major mergers with insurers. St. Louis–based insurer Cigna announced plans in March to buy Express Scripts for about $52 billion, after CVS Health announced plans in December to buy insurer Aetna.