FTC releases long-awaited report on PBMs

July 9, 2024

The Federal Trade Commission has published an interim report on the prescription drug middleman industry, underscoring the impact pharmacy benefit managers (PBMs) have on the accessibility and affordability of prescription drugs.

The 73-page report, which is part of  the FTC's ongoing inquiry launched in 2022, details how increasing vertical integration and concentration has enabled the six largest PBMs to manage nearly 95% of prescriptions filled in the U.S.

According to the FTC, the agency issued orders to the six largest PBMs — Caremark Rx, Express Scripts, OptumRx, Humana Pharmacy Solutions, Prime Therapeutics and MedImpact Healthcare Systems — over two years ago, requesting data and documents regarding their businesses and business practices. While the FTC says some companies haven't fully complied, the published report consists of key insights supported by the documents and data obtained to date.

“The FTC’s interim report lays out how dominant pharmacy benefit managers can hike the cost of drugs — including overcharging patients for cancer drugs,” said FTC Chair Lina M. Khan. 

The report also found that PBMs hold substantial influence over independent pharmacies by "imposing unfair, arbitrary and harmful contractual terms" that can impact pharmacies’ ability to stay in business.

According to Khan, the FTC plans to continue to use all its "tools and authorities" to "scrutinize dominant players across health care markets and ensure that Americans can access affordable health care.”