The Federal Trade Commission released an interim report yesterday on pharmacy benefit managers, highlighting concerns about their impact on drug pricing and accessibility. The two-year investigation found the six largest PBMs manage nearly 95% of all prescriptions filled in the US, with the top three—CVS Caremark, Express Scripts, and OptumRx—controlling about 80%.
PBMs act as pharmaceutical middlemen, deciding which drugs are covered and often setting patient out-of-pocket costs. The report (see here) suggests PBMs may be overcharging for certain drugs, imposing unfair contract terms on independent pharmacies, and steering patients toward higher-cost pharmacies. The FTC claims these practices resulted in nearly $1.6B in revenue for the three biggest pharmacies from just two cancer drugs over three years. PBMs have disputed the report's conclusions, maintaining their practices save money for employers, the government, and patients.
The findings could potentially lead to further investigations, legal action, or increased regulatory efforts at both federal and state levels.
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