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July 9, 2024

New FTC Investigation Report Targets PBMs

In its initial report on an antitrust investigation into the role of pharmacy benefits managers (PBMs), the competitiveness watchdog Federal Trade Commission (FTC) says PBMs have vast power that disadvantages consumers and independent pharmacies. It reports the following:

  • Consolidation and vertical integration of health plans and PBMs have impacted price and accessibility and led to anti-competitive behavior.
  • Independent pharmacies suffer broadly from the trends in the PBM industry.
  • It criticized narrow and preferred network strategies, formulary and rebate arrangements, and specialty pharmacy arrangements.
  • It noted that 80% of all PBM business is controlled by just three major entities – United’s Optum, CVS’ Caremark, and Cigna’s Express Scripts.
  • Arrangements with owned entities, including retail pharmacies, mail-order pharmacies, and specialty pharmacies, hurt consumers.

The major PBM lobbying group pushed back on the findings vigorously.  While PBMs need reform and more transparent approaches, I feel the FTC has put the entire onus for high prices and anti-competitive behavior on PBMs and not brand drug makers. The FTC has adopted the same whipping boy mentality as Congress.

Additional articles: https://www.fiercehealthcare.com/payers/ftc-report-pbms-may-urgently-require-potential-regulation and https://www.modernhealthcare.com/politics-policy/pharmacy-benefit-managers-pbms-higher-prices-ftc-cvs-cigna-unitehealth and https://thehill.com/policy/healthcare/4762024-federal-trade-commission-report-pharmacy-middlemen-price-hikes/

(Some articles may require a subscription.)

#pbms #drugpricing

https://www.healthcaredive.com/news/ftc-pharmacy-benefit-manager-investigation-interim-report/720814

Physician Burnout Declining

The portion of physicians who report at least one symptom of burnout has dropped below 50%, the first-time since the beginning of the COVID-19 pandemic.

#covid #providers #physicians

https://www.fiercehealthcare.com/providers/physician-burnout-drops-below-50-first-time-2020-ama-poll-finds

Sackler Family May Be Sued By Its Own Company’s Creditors

In light of the Supreme Court decision striking the far-reaching bankruptcy settlement, creditors of opioid maker Purdue Pharma have sought permission from the bankruptcy court to sue the company’s wealthy owners, the Sackler Family.  I say just desserts given the role the family played in the opioid crisis. The Supreme Court rightfully struck down a sweet-heart deal that would have protected the vast wealth of one of America’s richest families, which was earned through fraud, deception, and the misery of millions of Americans.

#opioids #settlement

https://www.reuters.com/legal/purdue-creditors-seek-approval-sue-sackler-family-members-2024-07-08

Hospital Performance Stable

Hospital financial performance remained relatively unchanged during the month of May, reflecting stabilization.

#hospitals #healthcare

https://www.beckershospitalreview.com/finance/hospital-margins-dip-to-3-8-gap-between-high-and-low-performers-widens.html

Kansas Rejects Medicaid Managed Care Contract Appeals

The Kansas Department of Administration rejected appeals to state Medicaid managed care contract denials for both Aetna and CareSource.

#ks #medicaid #healthplans #managedcare 

https://www.beckerspayer.com/contracting/kansas-rejects-aetnas-medicaid-challenge.html

— Marc S. Ryan

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