Jun 8, 2022 - Health

FTC launches probe of pharmacy benefit managers

Illustration of a pill with the dividing line in the shape of a dollar bill sign.
Illustration: Aïda Amer/Axios

After deadlocking on the issue earlier this year, the Federal Trade Commission is launching an inquiry into the business practices of pharmacy benefit managers (PBMs) and how they influence drug prices and the pharmacy business.

The big picture: The prescription drug middlemen have been an increasingly prominent target of finger-pointing as players up and down the drug supply chain try to pass off blame for rising drug costs.

Driving the news: The FTC unanimously voted Tuesday to require the six biggest PBMs — CVS Caremark, Express Scripts, OptumRx, Humana, Prime Therapeutics and MedImpact Healthcare Systems — to turn over information and records.

  • There are no specific allegations of wrongdoing, but practices to be scrutinized include familiar points of contention like how PBMs negotiate drug prices on behalf of health plans and decide which medicines get preferential treatment, according to an analyst note from Evercore ISI.
  • "This study will shine a light on these companies' practices and their impact on pharmacies, payers, doctors and patients," said FTC chair Lina Khan in a statement.
  • The FTC in February deadlocked on a motion to study the highly concentrated PBM sector, but the recent confirmation of a fifth commissioner created a Democratic majority and changed the outlook for an investigation.

The other side: Some say the FTC should focus on the entire drug supply chain and not just on the middlemen to get at the root causes of price hikes.

  • The Pharmaceutical Care Management Association, which represents PBMs, says its members are doing what health plans ask and aren't pocketing what they extract from drugmakers.
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