The US Federal Trade Commission (FTC) has launched an investigation into three major pharmacy benefit managers, accusing them of inflating drug prices by hundreds or thousands of percent at their affiliated pharmacies. The companies, UnitedHealth Group, Optum, CVS Health, Cigna’s Express Scripts, and their subsidiaries, have netted $7.3 billion in revenue in excess of the acquisition costs of the drugs.
According to the FTC report, the companies mark up prices significantly, with dispensing patterns suggesting they steer more profitable prescriptions to pharmacies that own them. The report also found that the companies pay those pharmacies more than unaffiliated pharmacies for nearly every drug.
The investigation follows a previous lawsuit by the FTC against two other PBMs, accusing them of steering patients toward higher-priced insulin products. The three companies have defended their practices, calling the FTC’s suit baseless.
Lawmakers are now pushing to curb the influence of PBMs on drug costs. CVS Health and UnitedHealth Group recently asked the FTC to disqualify its chair from the insulin lawsuit, citing alleged bias against their pricing model.
The FTC spokesperson said the $7.3 billion figure is likely an underestimate, as it only accounts for a subset of medications. The report highlights the need for greater transparency in the pharmacy benefit management industry, which acts as a middleman between drug companies and consumers.
The investigation and potential lawsuits may lead to changes in how PBMs operate, potentially affecting the prices of prescription drugs and the patients who rely on them.
Source: https://www.reuters.com/business/healthcare-pharmaceuticals/us-ftc-finds-major-pharmacy-benefit-managers-inflated-drug-prices-73-billion-2025-01-14