On Sept. 20, the Federal Trade Commission (FTC) brought action against the three largest pharmacy benefit managers (PBMs) – Caremark, Express Scripts, and OptumRX – and their affiliate entities for engaging in anticompetitive practices to artificially inflate the list price of insulins, thereby reducing patients’ access to lower-cost products and shifting costs onto vulnerable patient populations.
FTC alleges the PBMs have systemically excluded lower-cost products in favor of high list price, highly rebated products. According to the complaint, as insulin list prices increased, manufacturer rebates and fees paid to the PBMs also increased. The escalating rebates and fees collected by the PBM, in principle, should have significantly reduced the cost of these drugs for patients at the pharmacy counter and health plan sponsors. However, FTC alleges the PBMs conspired to inflate costs without producing any additional services or benefits. FTC says it is considering additional enforcement actions against manufacturers, who they say play a “concerning and active role” in the challenged conduct.
FTC’s investigative conclusions and actions towards PBMs align with ASHP’s statement to FTC regarding anticompetitive practices of large PBMs. ASHP’s ongoing podcast series, ASHP on PBMs, continues to unpack the crucial details of FTC’s ongoing investigation into PBMs and analyze the latest updates on regulatory actions.
