FTC chair Lina Khan has PBMs in her sights. Photo: Saul Loeb-Pool/Getty Images
The Federal Trade Commission will vote Thursday on whether it will study how pharmacy benefit managers affect drug prices and the businesses of pharmacies.
Why it matters: PBMs are powerful, secretive and heavily consolidated, and it appears the FTC is open to scrutinizing the industry that got significantly more concentrated under the FTC's own watch.
The intrigue: The FTC did not respond to requests for more information about what the study could include.
- But one of the FTC's targets likely will be fees PBMs claw back from pharmacies — fees the federal government is also targeting in a new proposed regulation.
Flashback: Over the past two decades, the FTC has blessed a plethora of mergers and acquisitions that led to the current situation, in which three PBMs — CVS Caremark, OptumRx and Express Scripts — control 80% of the market.
- CVS bought Caremark in 2007 (just three years after Caremark bought AdvancePCS).
- UnitedHealth, which owns OptumRx, has acquired several competing PBMs since 2015, including Catamaran, Diplomat and Helios.
- Express Scripts, now owned by Cigna, acquired NextRx in 2009 and Medco in 2012.
The Express Scripts-Medco deal caused considerable consternation among antitrust experts, but the FTC ultimately cleared it.
- Former FTC commissioner Julie Brill was the sole dissenting vote, writing: "While I sincerely hope that I am wrong about the effects of this merger, I believe — with deep sadness and concern — that will not prove to be the case."