The move signals
“Although many people have never heard of pharmacy benefit managers, these powerful middlemen have enormous influence over the US prescription drug system,” FTC Chair
The drug-plan middlemen have come under increasing scrutiny in recent years, as formerly independent PBMs have been folded into larger enterprises that also operate health insurers, pharmacies and care delivery companies. The FTC said its inquiry will examine that vertical integration. Critics say the PBMs operate in obscure ways, making money from health plan clients, rebates and fees collected from drugmakers.
The FTC will also seek documents from
“We look forward to working cooperatively with the Federal Trade Commission,” Phil Blando, a spokesman for CVS Health, said in an email. Prime Therapeutics intends to cooperate with the inquiry, Mike Kolar, the company’s general counsel, said in an email. The other companies named didn’t immediately comment.
The trade group representing the PBM industry said they lower drug prices and blamed drugmakers for the “root cause” of prescription drug costs. “We are confident that any examination of pharmacy benefit managers, PBMs, will validate that PBMs are reducing prescription drug costs for consumers,”
The commission voted 5-0 to approve the probe. That’s a reversal from a 2-2 deadlock earlier this year on a similar proposal, which the agency’s Republican members blocked from moving forward. Those commissioners said the new inquiry included their requests to look at how PBM industry practices have contributed to rising out-of-pocket drug costs for consumers.
The study also raises specific questions about PBM coverage of insulin, an issue on which Congress is considering legislation. The House in March passed a bill to cap the cost of insulin at $35 per month, though the Senate has yet to vote on its version of the legislation.
The FTC probe will look at fees to pharmacies, how PBMs steer patients to affiliated pharmacies, reimbursement methods and the role of rebates and fees from drugmakers, according to the FTC.
(Updates with Prime Pharmaceutical comment in sixth paragraph)
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