Jeff Berkowitz’s Post

The Federal Trade Commission (FTC) has just spotlighted some of healthcare’s most shadowy players. In a 71-page report, the agency blasted pharmacy benefit managers (PBMs) as “powerful middlemen” responsible for inflated drug costs. This newfound scrutiny marks a regulatory U-turn towards an industry where ~80% of US prescriptions are priced by three companies. https://lnkd.in/grwmcYR9

Americans are finally pushing back on the preferred networks (#PPN) that #PBMs and #Biginsurance have used for 30+ years to rob patients of their right to choose where and from whom to receive pharmacy care. We wish forceful leaders like Douglas Hoey and our US friends and colleagues success in this huge battle. Canadians can avoid the same carnage; before patient care is harmed, thousands of small employers are put out of business, and even our largest corporate chains are bought or controlled by big insurance as happened south of the border. (Express Scripts’ US insurance parent is 5x larger than Loblaw Companies) And the solution is easy with no ongoing costs. 8 million Quebeckers have been protected from PBMs and PPNs for 8 years by a simple law called #Bill92. The other 32 million Canadians deserve nothing less. #MirrorBill92 #IfYouArentAtTheTableYoureOnTheMenu #Careb4Commerce #BetterCareIsBetterBusinessAnyway

Crisis indeed. The unsustainable reimbursement rates and predatory contracting policies of the nation's largest Pharmacy Benefit Managers (PBMs) toward small independent community pharmacies is truly appalling (and getting worse). Without a combination of legislative action and actual enforcement of existing law, the alarming trend of pharmacy closures we have been experiencing throughout the country will most certainly continue.

How Drug Middlemen Keep Beating the System A Federal Trade Commission report released this week shows how three of the big names in the Pharmacy Benefit Manager (PBM) industry take advantage of their market share to keep prices high. But the report’s findings were not conclusive enough to charge them with wrong-doing. Scary? Yes. As happens often, there are just a handful of companies that dominate an industry. Unfortunately, in this situation, they steer customers towards a favored pharmacy, one that is usually owned by the PBM, and charges a lot more. From the article, “To be clear, the FTC report pointed to very specific ways in which middlemen are creating conflicts of interest and pushing costs higher.” This may appear hopeless if you’re looking to keep your company’s benefit costs affordable. Unless of course you’re in the industry as I am. Here at Equinox, we pay attention to such details as we value what is best for our clients. We’re adamant about using a PBM that is transparent and working to keep costs down. From these findings, it’s clear the big boys on the block are not. Ensure the benefits manager you’re trusting has your best interests in mind. If you’re not sure, let’s sit down and review your program. #PBM #benefitsmanager #FTC https://lnkd.in/gRMH4zDi

On July 9, 2024, the Federal Trade Commission (FTC) Office of Policy Planning released an Interim Staff Report titled Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies. The Interim Staff Report reflects the FTC’s work since it began its 6(b) study of PBMs in June 2022. Mintz’s Health and Antitrust teams actively monitor federal and state regulatory and legislative developments in the PBM space, including those from the FTC. In this Special Edition of the PBM Policy and Legislative Update, the Mintz Health team partnered with our Antitrust colleagues to analyze the Interim Staff Report including Commissioner Melissa Holyoak’s dissenting statement. We also highlight upcoming Congressional testimony by CEOs of the three largest PBMs, as well as media reports of a forthcoming FTC action related to PBM insulin rebate practices.

House of Representatives passed the Lower Costs, More Transparency Act (H.R. 5378). National Community Pharmacists Association (NCPA) comment on the impact of the act: “Community pharmacy has been pushing consistently for the last 15 years for transparency into PBM operations and reforms to their tactics. During that time, care has only grown more difficult for patients to afford and to access and for pharmacies to provide. This legislation would help provide desperately needed relief while also saving taxpayer resources, prohibiting spread pricing and seeing that pharmacies are paid in a way that would cover their dispensing costs. We’re grateful to our allies in Congress for keeping PBM reforms on their agenda and are eager to see these and other changes enacted as quickly as possible.” #pharmacist #independentpharmacy #communitypharmacy #primaryhealthcare

Nearly 30 drugmakers are defying long-standing federal policy by restricting #340B pricing on drugs dispensed using community and specialty pharmacy partnerships.   These restrictions are the subject of ongoing legal battles. They cause significant financial strain for hospitals, harm patients, and raise drug costs for all Americans.   My latest op-ed in RealClearHealth has more: bit.ly/4a01l1Y

New on our website - what happened to LloydsPharmacy? This interactive report explores the history of the pharmacy chain as well as some revealing insights on which branches have closed or sold, and which pharmacy operators have been most actively purchasing these pharmacies. Visit https://lnkd.in/e6awuk-g to read the full article.

We're sharing our speaker notes from last weeks #pharmacydisruption event. These comments stood out- What are your thoughts? 1. The price (prescription price) needs to be lower up front- chasing rebates is a thing of the past. 2. Consumers should have choice at the point of sale- see the price with their co-pay and see the price with a discount card, then choose their best option. 3. Companies are going through all of these hoops to try and save but still not getting it right. Thanks again Christopher Brown, Chris Pierce, Ryan Duffy Ferrin Williams, PharmD MBA, Robyn Piper and Mark Lyons for their insights! #specialtypharmacy #specialtymedication #pharmacyrebates #pharmacy #employeebenefits #pharmacybenefits #healthinsurance

Endpoints News summarizes some of the findings by the #FTC report om #PBMs that came out this morning. While disappointed that no anti-trust action is being taken - the FTC report is described as an "interim" product. It lists many of the PBM actions that are raising prices for the system and patients alike, and driving independent pharmacies out of business, all for the sake of profit. It is stated that more scrutiny and investigations are warranted. As expected the FTC is not getting much information from the big 3's rebates aggregators (GPOs) 2 of which are off shore. This not surprising as it appears these may have been created in response to much of the legislation that is demanding transparency. Let's hope that anti-trust actions will be taken by the FTC in the future.