Pharmacy Benefit Managers have been one of the most powerful and least discussed segments of the healthcare industry—until recently. Over the last year, PBMs have been investigated by both the press and Congress. Now, PBMs are center stage for the FTC.
The Federal Trade Commission has turned its attention to these powerful intermediaries, initiating a lawsuit that could reshape the landscape of pharmaceutical benefits management. The FTC has taken an initial stance against some of the practices of the three largest pharmacy benefit managers—CVS Caremark, Express Scripts, and OptumRx—by filing a lawsuit that alleges anticompetitive practices. The FTC claims that these PBMs are manipulating the market by steering patients towards more expensive drugs, driven by higher rebates from manufacturers, and excluding cheaper alternatives from their formularies. This lawsuit aims to bring transparency and fairness to the prescription drug market, addressing the conflicts of interest and high costs burdening consumers.
Given the range of complaints that have been made by others over the last several years—consumers, independent pharmacies, pharmaceutical manufacturers, employers, and other stakeholders—the scope of the FTC’s complaint is a modest one.
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