The Federal Trade Commission (FTC) has released an interim staff report on the prescription drug middleman industry. The report examines the numerous ways pharmacy benefit managers (PBMs) affect prescription drug accessibility and affordability.
According to an FTC press release, the interim report, required by a special order issued by the FTC in 2022, outlines how increased vertical integration and concentration have contributed to the rise of six PBMs that now manage almost 95% of the nation’s prescriptions.
The FTC asserts that this vertical integration and concentration have led to PBMs profiting at the expense of patients and independent pharmacists. "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 M. Khan stated in the press release. "The report also details how PBMs can squeeze independent pharmacies that many Americans—especially those in rural communities—depend on for essential care."
According to the press release, the report reveals that PBMs influence the availability of prescription drugs and what consumers pay for them. Higher drug prices force some patients to modify how often they use a medication. The report points to a survey that shows nearly 30% of Americans ration or skip doses to manage the steep prices.
Furthermore, according to the press release, the report shows that PBMs command significant influence over independent pharmacies, mainly through unfair, arbitrary, and harmful contractual terms that they impose. In addition, it highlights how pharmacies affiliated with the three largest PBMs currently account for nearly 70% of all specialty drug revenue.
The interim report was published under Section 6(b) of the FTC Act and focuses on six large PBMs: Caremark Rx, LLC; Express Scripts, Inc.; OptumRx, Inc.; Humana Pharmacy Solutions, Inc.; Prime Therapeutics LLC; and MedImpact Healthcare Systems, Inc.
