Bravo to American Pharmacy Cooperative, Inc. for Calling On “Big 3” PBMs’ Largest Investor to Use Its Influence To Restrain PBM Economically Damaging Practices


This week American Pharmacy Cooperative, Inc. (APCI) took a bold step in the ongoing campaign for PBM reform: they openly called on Vanguard Inc., the largest investor in the parent companies of the “Big 3” pharmacy benefit managers (PBMs), to use its influence to curtail their PBMs’ abuse of patients and pharmacies.

“As one of the largest investors in United Healthcare, CVS, and Cigna, Vanguard is in a unique position to help effectuate real and meaningful change on behalf of patients and the healthcare system in this country. APCI’s explicit request is that Vanguard stand with patients, providers, and lawmakers and demand that large PBMs end these practices that drive up the cost of prescription drugs at the counter, take away patient choice, and create barriers to care that lead to fragmentation, poorer adherence, and poorer patient outcomes,” Greg Reybold, APCI’s Director of Healthcare Policy, wrote to Vanguard Chairman and CEO Tim Buckley.

APCI sent the letter because of Vanguard’s significant investments in UnitedHealth Group, CVS, and Cigna. According to publicly available records, Vanguard is the largest institutional shareholder of UnitedHealth Group and CVS and the second largest institutional shareholder of Cigna. Vanguard owns more than 220 million shares of stock cumulatively among the three companies.

An appeal to Vanguard’s sense of environmental, social and governance (ESG) values, the point of the letter was to disabuse the firm’s executive management of any notions that by investing so heavily in the largest healthcare corporations they’ve somehow contributed to the wellbeing of patients, providers, or even the long term viability of the U.S. economic engines.

ESG factors are used by investors, analysts, and other stakeholders to assess the overall sustainability and ethical performance of companies. Evaluating ESG criteria provides insights into the company’s long-term prospects, risk management, and its ability to create value while considering environmental and social impacts. ESG considerations are increasingly important in investment decision-making, corporate reporting, and regulatory frameworks as companies aim to demonstrate their commitment to sustainability and responsible business practices.1

And yet just this week, Vanguard’s Buckley sidestepped conversations about ESG at an industry investment conference, stating “The objective’s quite clear: Make sure our clients win,”

Still, we at PUTT applaud and commend APCI for calling on Vanguard to use its influence to help end the unsustainable, socially and economically adverse practices PBMs engage in. Following their lead, we will follow up their letter with one of our own, and encourage our fellow advocacy and healthcare organizations to do the same.

Together, let us continue to champion patient rights and work towards a prescription drug system that prioritizes the well-being of those it serves.

Yours in advocacy,

Monique Whitney, PUTT Executive Director

1. Investopedia, “What is Environmental, Social and Governance (ESG) Investing?” Mar. 22, 2023.



Pharmacists United for Truth & Transparency

PUTT is a nonprofit organization dedicated to advocating on behalf of independent pharmacy & fighting against PBM anti-competitive business tactics.