FTC finds major pharmacy benefit managers inflated drug prices for $7.3 billion gain

Key Points

  • The three largest pharmacy benefit managers (PBMs) in the U.S. have significantly increased the prices of certain medications at their pharmacies, leading to an excess revenue of $7.3 billion over acquisition costs from 2017 to 2022.
  • The Federal Trade Commission (FTC) has accused these PBMs of steering patients towards more expensive insulin products to gain higher rebates from drug manufacturers.
  • The PBMs involved, CVS Health's CVS Caremark, UnitedHealth Group's Optum, and Cigna's Express Scripts, have defended their pricing practices and challenged the FTC's accusations, including requesting the disqualification of FTC Chair Linda Khan due to alleged bias.

Summary

The Federal Trade Commission (FTC) has reported that the three largest pharmacy benefit managers (PBMs) in the U.S. — CVS Health's CVS Caremark, UnitedHealth Group's Optum, and Cigna's Express Scripts — have been marking up the prices of certain medications by hundreds or thousands of percent at their pharmacies. This practice, spanning from 2017 to 2022, resulted in an additional $7.3 billion in revenue over the cost of acquiring the drugs. The FTC highlighted this issue in its second report on the industry, focusing on how these PBMs, which act as intermediaries between drug manufacturers and consumers, have been manipulating drug prices to their advantage. The FTC has also accused these companies of directing patients towards pricier insulin options to secure larger rebates from drugmakers. Despite these allegations, the PBMs maintain that their practices are justified and have criticized the FTC's approach, particularly targeting FTC Chair Linda Khan for alleged bias. The controversy continues as the FTC, supported by bipartisan lawmakers, aims to reform PBM practices, while the companies argue that proposed regulations could increase costs for consumers and benefit the pharmaceutical industry.

cnbc
January 14, 2025
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