Michelle ThompsonPharmacy benefit managers (PBMs), who manage prescription drug access for millions of Americans, are profiting while putting pressure on patients and independent pharmacies, according to an interim staff report by the Federal Trade Commission (FTC) released Tuesday.
The FTC’s inquiry, started in 2022, revealed that a few dominant PBMs have significant control over patients’ access to and affordability of prescription drugs, determining which medications are available and at what cost. These PBMs also exert substantial influence over independent pharmacies, imposing unfair contractual terms that threaten their ability to operate and serve communities.
The report highlights that the six largest PBMs, including CVS Caremark, Express Scripts, and Optum Rx, control nearly 95% of prescriptions in the US. These PBMs are often owned by or connected to health insurers and affiliated with pharmacies, potentially steering patients to their own pharmacies instead of independent ones.
In recent years, the Biden administration and Congress have aimed to increase transparency in the PBM industry, which is partly blamed for rising medication costs. The PBM industry’s trade group criticized the FTC’s report as being based on anecdotal evidence and not representative of the entire market, arguing that it overlooked data showing PBMs’ role in reducing prescription drug costs.
Commissioner Melissa Holyoak also criticized the report, citing procedural issues and concerns over its substance.
CVS Caremark defended its practices, stating that it helps protect American businesses, unions, and patients from rising drug prices, with members paying less than $8 on average for a 30-day supply of medication. They also claimed that net brand drug prices have declined for six consecutive years.
Conversely, the pharmaceutical industry’s main trade group, PhRMA, supported the FTC’s findings, arguing that PBMs prioritize profits over patients and significantly influence drug availability and pricing.
