Federal Trade Commission’s Report Highlights PBMs’ Influence Over Drug Costs and Access in the US

In July 2024, the Federal Trade Commission (FTC) published an interim report discussing the impact that pharmacy benefit managers (PBMs) have on the accessibility and affordability of drugs in the US. The report was issued as part of an ongoing investigation that began in 2022 under Section 6(b) of the FTC Act.

According to the report, the six largest PBMs (Caremark Rx, Express Scripts, OptumRx, Humana Pharmacy Solutions, Prime Therapeutics, and MedImpact Healthcare Systems) manage 95% of prescriptions filled in the country thanks to increasing vertical integration and concentration. This structure allows them to be integrated with the largest health insurers and specialty and retail pharmacies in the US. The pharmacies affiliated with the three largest PBMs account for almost 70% of all specialty drug revenue, according to the FTC.

The report also states that PBMs can hike the cost of drugs, including drugs for cancer care, impacting patients and what they can afford. “PBMs oversee these critical decisions about access to and affordability of life-saving medications, without transparency or accountability to the public,” said the FTC.

In addition, PBMs hold influence over independent pharmacists, especially those in rural areas, by imposing unfair and harmful contractual terms that can impact their ability to stay in business. They also may steer patients away from smaller, independent and local pharmacies, instead driving them to their affiliated pharmacies.

For the PBMs that have not been forthcoming and timely in their responses and have still not completed their required submissions, FTC staff have ordered them to finalize their productions required by the 6(b) orders promptly. “If, however, any of the companies fail to fully comply with the 6(b) orders or engage in further delay tactics, the FTC can take them to district court to compel compliance,” said the FTC.

Reference

Pharmacy benefit managers: the powerful middlemen inflating drug costs and squeezing main street pharmacies. Federal Trade Commission. Accessed on September 6, 2024. https://www.ftc.gov/reports/pharmacy-benefit-managers-report