PBM Industry Faces Scrutiny as Express Scripts Executive Takes PCMA Board Chair

In a significant development for the pharmacy benefit manager (PBM) industry, Adam Kautzner, president of Express Scripts, has been appointed as the new board chair of the Pharmaceutical Care Management Association (PCMA). This move comes at a time when PBMs are under increasing scrutiny for their role in rising drug costs and market concentration.

PCMA Leadership Shift Amid Industry Challenges

Adam Kautzner, who also serves as president of care management for Cigna's health services division, will now oversee the PCMA's strategy. The PCMA, an influential lobby representing major PBMs including Express Scripts, CVS Caremark, and UnitedHealth's Optum Rx, has been actively defending the industry against growing criticism.

In addition to Kautzner's appointment, the PCMA has created a new affiliate council to represent its mid-market clients. Jeff Park, president of drug pricing platform Waltz Health, will hold a new seat on the PCMA's board to represent this segment.

Intensifying Scrutiny of PBM Practices

PBMs, which negotiate discounts with drugmakers and control medication placement on plan formularies, have come under fire for various practices:

• Critics argue that PBM rebating practices may curtail access and potentially inflate drug list prices.
• Concerns have been raised about whether payer clients and patients are benefiting from PBM-negotiated savings.
• Allegations of PBMs strong-arming independent pharmacies into unfavorable contracts have surfaced.
• Antitrust regulators are examining market concentration, with Express Scripts, Caremark, and Optum Rx processing approximately 80% of all U.S. prescriptions.

Legislative Pressure and Industry Response

The PCMA's defensive efforts have intensified as legislative interest in PBM reform has grown:

• The lobby spent over $17.5 million on lobbying in 2024, a 14% increase from the previous year.
• In the first seven months of 2025, PCMA's lobbying expenditure nearly matched its entire 2022 spending.
• Despite Congress failing to pass bipartisan PBM reform legislation in late 2024, momentum for change has continued into 2025.
• Legislators have introduced bills aimed at preventing PBMs from profiteering within the pharmaceutical supply chain.

The PCMA has responded by launching ad campaigns blaming drugmakers for high drug prices and funding research to demonstrate PBM value for patients. The lobby also argues that the PBM market remains competitive despite the dominance of the "Big Three."

As the pharmaceutical industry continues to evolve, the appointment of Adam Kautzner as PCMA board chair signals a critical juncture for PBMs. The industry's ability to navigate increasing scrutiny and potential regulatory changes will likely shape the future landscape of drug pricing and access in the United States.