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FTC Launches Inquiry into PBM Business Practices

The Federal Trade Commission unanimously voted to examine the impact that vertically integrated pharmacy benefit managers have on the access and affordability of prescription drugs, which will provide greater insight into an opaque part of the health care industry. 

HR Policy recently joined other business groups in urging the FTC to launch an investigation into PBM practices and recommended the commission study the effect of horizontal and vertical consolidation on drug prices for employers and their employees.

The inquiry is aimed at shedding light on several practices, including:

  • The complicated and opaque methods that determine pharmacy reimbursement;

  • The use of specialty drug lists and surrounding specialty drug policies;

  • The impact of rebates and fees from drug manufacturers on formulary design and the costs of prescription drugs to payers and patients; and

  • The methods to steer patients towards PBM owned pharmacies.

JC Scott, chief executive officer of the Pharmaceutical Care Management Association, said “We are confident that any examination of PBMs will validate that PBMs are reducing prescription drug costs for consumers.”

Outlook: It is unclear if the FTC will take other action when the commission completes its inquiry, which may not be until 2023.  It is also unclear if Congress will move any PBM legislation to act on the FTC’s report.

Published on: June 10, 2022

Authors: Margaret Faso

Topics: Transparency, Quality and Cost Containment

Margaret Faso

Director of Health Care Research and Policy, American Health Policy Institute and HR Policy Association

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