Pharmacy benefit managers (PBMs) have been accused of inflating prices of specialty generic drugs, reaping $7.3 billion in revenue between 2017 and 2022. The Federal Trade Commission (FTC) said the nation’s three largest PBMs – CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealth Group’s Optum Rx – marked up prices by hundreds or thousands of percent.
The PBMs reimburse their affiliated pharmacies at a higher rate than unaffiliated pharmacies on nearly every specialty generic drug. The FTC reviewed 51 such drugs, including those for heart disease, cancer, and HIV.
Critics argue that the Big 3 PBMs’ practices unfairly burden plan sponsors and their members. The agency’s investigation began in 2022 and led to lawsuits against Caremark, Express Scripts, and Optum Rx, accusing them of artificially inflating insulin list prices.
The companies dispute these findings, claiming they reduce drug costs. Optum Rx said it helped eligible patients save $1.3 billion in 2024 by providing clinical expertise and support for complex conditions. Caremark argued that the FTC’s data “cherry-picked” specialty generic outliers and ignored its cost-saving guarantees.
Congress has raised concerns about PBMs’ opaque practices, which have drawn scrutiny from lawmakers and critics. Efforts to overhaul the industry may continue under the incoming Trump administration, which plans to tackle PBM practices as part of its efforts to reduce healthcare costs.
Source: https://edition.cnn.com/2025/01/14/business/drug-price-mark-up-ftc-pbm/index.html