Pharmacy benefit managers, which companies hire to reduce their prescription drug costs, inflate prescription drug costs, Federal Trade Commission investigators found.
The FTC research also said PBMs, which act as middlemen in the industry, inflate costs and pressure independently owned pharmacies. PBMs said the study was flawed.
“The FTC’s interim report lays out how dominant pharmacy benefit managers can hike the cost of drugs – including overcharging patients for cancer drugs,” FTC Chair Lina Khan said in a statement. “The report also details how PBMs can squeeze independent pharmacies that many Americans – especially those in rural communities – depend on for essential care.”
The findings come after two years of study and calls from some lawmakers to address the issues presented by PBMs.
The FTC requested documents from the six biggest PBMs. The top three PBMs processed nearly 80 percent of the approximately 6.6 billion prescriptions dispensed by U.S. pharmacies in 2023, while the top six PBMs processed more than 90%. Pharmacies affiliated with the three largest PBMs account for nearly 70% of all specialty drug revenue.
The three largest PBMs are UnitedHealth Group’s OptumRx, Cigna’s Express Scripts and CVS Health’s Caremark.
The Commission voted 4-1 to allow staff to issue the interim report, with Commissioner Melissa Holyoak voting no.
PBMs rejected the report and its findings, said Pharmaceutical Care Management Association President and CEO JC Scott.
“Today’s interim FTC report falls far short of being a definitive, fact-based assessment of PBMs or the prescription drug market. Members of the commission themselves disagree with the content of the report and the decision to release it,” he said in a statement. “This report is based on anecdotes and comments from anonymous sources and self-interested parties, and supported only by two cherry-picked case studies that are implied to be representative of the entire market.”
Scott said PBMs provide value to the health care system.
“Throughout this process, FTC leadership has shown that they have pre-determined conclusions that they want to advance irrespective of the facts or the data, and this report demonstrates an intention to follow through on their agenda regardless of the evidence,” he said.
