The Federal Trade Commission says pharmacy benefit managers have inflated drug costs while squeezing independent pharmacies, enriching some of the largest companies in the U.S. at the expense of patients.
An interim FTC report released Tuesday details the market influence of companies known as PBMs, which are hired and, in many cases, owned by health insurers to manage drug benefits within heath plans. Their roles can include everything from setting co-pays for medications to creating pharmacy networks where patients can fill prescriptions.
Camilla Hancock fills a prescription at Basin Pharmacy in Basin, Wyo., Feb. 21. Mike Clark/Associated Press
Eagan-based Prime Therapeutics and OptumRx, a division of Minnetonka-based UnitedHealth Group, were two of six PBMs singled out in the report.
“The FTC’s interim report lays out how dominant pharmacy benefit managers can hike the cost of drugs — including overcharging patients for cancer drugs,” FTC Chair Lina Khan said in a statement. “The report also details how PBMs can squeeze independent pharmacies that many Americans — especially those in rural communities — depend on for essential care.”
The trade group for PBMs cried foul Tuesday, saying the report “falls far short of being a definitive, fact-based assessment” and didn’t live up to FTC’s history for objectivity.
The Pharmaceutical Care Management Association said in a statement that some members of the commission disagreed with the report’s content as well as the decision to release it. The report was based on anecdotes, anonymous comments, and “cherry-picked case studies,” according to the trade group.
“Throughout this process, FTC leadership has shown that they have pre-determined conclusions that they want to advance irrespective of the facts or the data, and this report demonstrates an intention to follow through on their agenda regardless of the evidence,” the association said.
“Nothing can change the fact that PBMs are operating in an extremely competitive market and have a proven track record of reducing prescription drug costs.”
In 2022, FTC launched its review of PBMs, a subject that was highlighted by commissioner Alvaro Bedoya during comments at a Minneapolis event in 2022 on economic competition.
Last month, Minnesota Attorney General Keith Ellison led a bipartisan group of 32 attorneys general asking the U.S. Supreme Court to review a case that could otherwise limit state regulation of PBMs.
In 2023, the state Commerce Department imposed a $500,000 fine against Rhode Island-based CVS Caremark, alleging the PBM used strategies not allowed under Minnesota law to steer consumers to its own pharmacies. CVS Caremark, which denied the allegations and did not admit liability, also was one of the six PBMs highlighted by the FTC’s interim report.
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