The Federal Trade Commission (FTC) has accused three major prescription benefit managers – Optum RX, CVS Caremark, and Express Scripts – of inflating cancer drug prices by 1,000%. The companies, which control 80% of the market, are alleged to be marking up reimbursement rates for specialty drugs at “hundreds and thousands of percent”.
The FTC released a study finding that PBMs like Optum RX increase their own pharmacy’s reimbursement rates for many specialty drugs. Reimbursement rates for cancer treatment medications were marked up over 100%, while those for transplant patients’ and HIV treatment medications increased by more than 1,000%.
Pharmacy benefit managers are typically supposed to act as middlemen to negotiate lower drug prices. However, the companies involved have been criticized for steering consumers towards their own pharmacies, driving independent pharmacists out of business.
Pharmacists across the country have spoken out against PBMs, saying they prioritize profits over patient care. One pharmacist testified that she sold baked goods to stay afloat due to her low margins.
The accusations come as the industry faces growing scrutiny from regulators and critics. The FTC’s report highlights concerns about “pharmacy deserts” and the impact of consolidation on competition.
OptumRx claims it is lowering costs, while Express Scripts says the report only focuses on a few drugs. CVS Caremark has not commented on the allegations.
Source: https://www.fox9.com/news/ftc-says-optum-other-prescription-benefit-managers-inflate-cancer-drug-prices-1000