West Health’s Post

The FTC has filed a lawsuit against Optum Rx, Express Scripts, and Caremark, alleging anticompetitive practices and artificially inflated insulin prices. Key points: - Anti-competitive practices: The FTC accuses PBMs of rigging the drug supply chain to increase profits. - Higher costs: Patients have faced higher out-of-pocket costs for insulin. - Industry response: PBMs deny wrongdoing and argue they have helped lower insulin prices. This lawsuit could have significant implications for the PBM industry and the affordability of prescription drugs. Learn more: https://hubs.ly/Q02QNr7x0

The FTC's Interim Staff Report on the PBM industry claims that vertical integration and market consolidation have allowed a few PBMs to exert power over drugs and consumer prices as well as unaffiliated pharmacies. It also also attempts to explain some of the complexities in how PBMs operate within the healthcare industry that may lead to high drug costs, including the use of specialty prescription designations, steering mechanisms, and preferential reimbursement rates for PBM-affiliated pharmacies. Read more in this client alert from me and my Covington & Burling LLP colleagues Rujul Desai, Alezeh Rauf, and Katelynn Pan.

The Federal Trade Commission (FTC) has released an interim report on its investigation into pharmacy benefit managers (PBMs), revealing concerning practices that may harm patients, pharmacies, and employers. The report highlights issues such as PBMs steering patients to affiliated pharmacies, potentially limiting patient choice and raising costs. The investigation found that PBMs often engage in complex and opaque contracting practices, making it difficult for employers to understand the true costs of prescription drugs. Additionally, PBMs were found to use their market power to squeeze independent pharmacies through unfavorable reimbursement rates and fees. The FTC's report also raises concerns about vertical integration in the healthcare industry, with PBMs increasingly owning or being owned by insurance companies and pharmacies. This integration may create conflicts of interest and reduce competition. The interim findings suggest that PBM practices could lead to higher drug prices, reduced access to medications, and decreased competition in the pharmaceutical market. The FTC plans to continue its investigation and may consider policy recommendations or enforcement actions to address these issues. #healthcare #PBMs #BigPharma #HealthcareCosts #FTC #HealthcareCosts https://lnkd.in/eHBa2GjH

The Federal Trade Commission (FTC) has launched a lawsuit against the "Big Three" Pharmacy Benefit Managers (PBMs) over their drug pricing tactics. PBMs play a crucial role in negotiating prices between insurers, pharmacies, and drug manufacturers. However, critics argue that their complex rebate and fee structures can lead to higher prices for consumers and less transparency in the market. The FTC's action aims to address these issues and promote a more transparent and fair pricing system for prescription medications. This lawsuit could have significant implications for the future of drug pricing and the role of PBMs in the healthcare industry. https://lnkd.in/gJiEKMWN

"The 6 largest #PBMs (pharmacy benefit managers) in the US manage ~95% of all prescriptions filled in the US, a “concentrated market structure” that has allowed them to “profit at the expense of patients and independent pharmacists”. The Federal Trade Commission’s interim report lays out how dominant pharmacy benefit managers can hike the cost of drugs – including overcharging patients for cancer drugs.” Here are some strategies to mitigate these issues: 1. Require #PBMs to disclose the rebates they receive from drug manufacturers and how much of these rebates are passed on to insurers and patients. 2. Encourage or mandate the use of transparent pricing models where #PBMs provide clear information on how drug prices are set and what patients will pay out-of-pocket. 3. Federal and state legislation that increases oversight and regulation of #PBMs, such as laws that require #PBMs to act in the best interest of patients. 4. Strengthen regulations to prevent PBMs from engaging in practices that may lead to conflicts of interest, such as accepting kickbacks from drug manufacturers. 5. Support the development and use of alternative models, such as transparent #PBMs that operate on a flat fee rather than a percentage of drug costs. 6. Ensure that #PBM formularies are based on clinical efficacy and cost-effectiveness rather than on the size of rebates from manufacturers. 7. Expand access to patient assistance programs to help those who are struggling with high out-of-pocket costs. 8. Allow government programs like #medicare to negotiate drug prices directly with manufacturers, potentially bypassing #PBMs. 9. Encourage large employers and insurers to negotiate directly with drug manufacturers or use purchasing coalitions to increase their bargaining power. 10. Implement performance metrics and accountability standards to ensure that #PBMs are providing value to patients.

Hospitals and health systems nationwide – including The University of Vermont Health Network – are working hard to reduce costs without impacting patient care. But some things are outside our control. As this report shows, prescription drug prices are shaped in part by a complicated, opaque system. As we prepare for next fiscal year, rising pharmaceutical costs are having a significant impact on our hospitals’ budgets. It’s encouraging that state leaders in Vermont and New York have taken action to better regulate pharmacy benefit managers. Just last week, Vermont’s attorney general filed a lawsuit against two PBMs who dominate the market, saying they are “driving up drug prices and foreclosing patients’ access to life-sustaining treatments in order to increase their profits.” The federal government can learn from the leadership our state leaders have shown, and can help shed further light on an issue that affects both health care providers and patients.

🚨 **Breaking News in Healthcare** 🚨 The Federal Trade Commission (FTC) is taking significant action against the largest pharmacy benefit managers (PBMs) over drug pricing tactics. Here are the key points: - **FTC Lawsuit**: The FTC is suing CVS Caremark, Express Scripts, and OptumRx for rebate practices that may increase drug costs and disadvantage independent pharmacies. - **Market Impact**: These PBMs handle around 80% of U.S. prescriptions and are integrated with major health insurers. - **Conflict of Interest**: The FTC report highlights how vertically integrated PBMs may prefer their affiliated businesses, potentially raising prescription drug costs. - **Consumer Impact**: The lawsuit aims to address how these practices affect consumers, particularly regarding the cost of essential medications like insulin. For more details, read the full article [here](https://lnkd.in/eCvzBTGq). #Healthcare #Pharmacy #DrugPricing #FTC #PBMs #LegalAction #Pharmaceuticals #RX 3PBM #FixHealthcare BenefitHelp : [Fierce Healthcare](https://lnkd.in/eCvzBTGq) : [BioSpace](https://lnkd.in/eJSb6Aqy)

As prescription drug costs remain a significant — and largely bipartisan — issue for state and federal legislators, we continue to see activity focused on pharmacy benefit managers. There are currently four bills under consideration that would have a direct or indirect impact on PBMs, as well as health plans, prescription drug manufacturers, wholesalers and pharmacies. You can learn more in this alert by Jay Warmuth, Evan Bonnstetter and Mason M.

The three biggest pharmacy benefit managers will come before the House Committee on Oversight and Accountability to explain their role in the increasing medication prices in the U.S., according to an announcement on Tuesday by committee Chairman James Comer (R-Ky.). The hearing, set for July 23, will include Adam Kautzner, president of Evernorth Care Management and Express Scripts, David Joyner, executive vice president of CVS Health and president of CVS Caremark, and Patrick Conway, CEO of OptumRx. According to Comer’s announcement, the session will probe how these pharmacy middlemen reinforce anticompetitive practices in the industry, in turn increasing prescription drug prices and compromising patient care. #biotech #biopharma #pharma #drugpricing #PBM

Are You Prepared for the Dramatic Shift in U.S. Prescription Drug Costs? Did you know the U.S. leads in per capita prescription drug spending, averaging $1,432 per American in 2021? This staggering figure is over 36% higher than our closest spending peer, Germany. With total spending hitting $378 billion in 2021, it's clear why 1 in 3 U.S. adults struggle to afford their prescribed medication. But there's a shift happening. The Inflation Reduction Act, passed by the Biden administration, is set to bring significant changes. Key features include cost-sharing caps on insulin and a $2,000 annual limit on out-of-pocket costs for Medicare Part D enrollees starting in 2025. This move alone could save nearly 19 million enrollees an average of $400 each year. Beyond these immediate reliefs, the act empowers the federal government to negotiate Medicare drug prices, projected to save over $100 billion in a decade. These steps, while monumental, mark just the beginning of a journey towards more comprehensive reforms. The path forward involves understanding the intricate pharmaceutical supply and financing chain. From manufacturers to pharmacy benefit managers (PBMs), wholesalers, and retail pharmacies, each link in this chain plays a critical role. And with policy interventions at multiple points, we can aim for a more affordable and transparent drug pricing system. As we navigate these changes, it's crucial for companies, HR professionals, and healthcare stakeholders to stay informed. Premier-Rx is committed to keeping you updated and providing solutions that align with these evolving dynamics. Together, we can work towards a future where healthcare is not only accessible but also affordable for all. #HealthcareReform #PrescriptionDrugs #InflationReductionAct #PremierRx"