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FTC: PBMs Drive Up Health Care Costs

Pharmacy benefit managers, originally formed to keep health care costs down, “instead steer patients away from less expensive medicines and overcharge for cancer therapies,” according to a Federal Trade Commission report out Tuesday, according to the The Wall Street Journal (subscription).

What’s going on: In a report that follows a two-year investigation into PBMs, the FTC “detailed a number of actions that it said large pharmacy-benefit managers use to boost their profits and increase the spending of the health plans and employers that hired them to control costs. The actions can also lead to higher outlays for patients at the pharmacy counter.”

  • The release of the investigative findings also comes after significant, ongoing advocacy by the NAM to Congress to reform PBMs—which operate with limited oversight—and an in-depth investigation by the New York Times.
  • Since the beginning of 2023, seven House and Senate committees have passed PBM-reform measures, and the NAM is pushing for the legislation to be signed into law this year.

Why it’s important: The report showed that PBMs’ practice of inflating list prices of innovative brand medications can be costly for patients.

  • “For certain Medicare patients and others who pay a percentage of their drug costs when they fill a prescription, the higher charges have meant higher out-of-pocket payments,” according to the Journal.

A troubling evolution: The FTC report also underscores how PBMs have adapted as scrutiny has increased, as highlighted in another The Wall Street Journal (subscription) piece.

  • “As rebate profits fell, PBMs increasingly turned to specialty pharmacies and other fees to boost their bottom lines. Some of those fees are collected by rebate aggregators known as group purchasing organizations,” which further increase costs for manufacturers and manufacturing workers.

The last word: The “FTC report highlights why Congress must take action on PBM reform that increases transparency, ensures PBMs do not pocket manufacturer rebates and delinks PBM compensation from the list price of medications,” the NAM wrote in a social post Tuesday.

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