The U.S. Federal Trade Commission (FTC) announced last week that it will investigate the “prescription drug middleman industry,” demanding information and records regarding the business activities of the country’s six largest pharmacy benefit managers (PBMs).
As Bio.News has reported, PBMs handle insurance companies’ prescription drug benefits. The FTC says that the six largest are now “vertically integrated with the largest health insurance companies and fully owned mail order and specialty pharmacies.”
In these roles, PBMs often have a lot of control over which prescriptions patients get, which pharmacies they can use, and how much they pay at the pharmacy counter, as Bio.News has reported. PBMs receive rebates and discounts on drug prices, which they’re supposed to pass on to patients—but they often don’t, and instead limit access via formulary exclusions, harming the sickest patients the most, Bio.News has reported.
“Although many people have never heard of pharmacy benefit managers, these powerful middlemen have enormous influence over the U.S. prescription drug system,” said Federal Trade Commission Chair Lina M. Khan. “This study will shine a light on these companies’ practices and their impact on pharmacies, payers, doctors, and patients.”
“As part of this inquiry, the FTC will send compulsory orders to CVS Caremark; Express Scripts, Inc.; OptumRx, Inc.; Humana Inc.; Prime Therapeutics LLC; and MedImpact Healthcare Systems, Inc,” the FTC said.