- The Federal Trade Commission will vote Thursday afternoon on whether to compel large pharmacy benefit managers to turn over information so the agency can conduct a study on the relationship between PBMs and independent and specialty pharmacies.
- In its agenda, the FTC said it's looking to examine the "competitive impact of contractual provisions, reimbursement adjustments, and other practices affecting drug prices, including those practices that may disadvantage independent or specialty pharmacies."
- The Pharmaceutical Care Management Association, which represents PBMs, said they "welcome any opportunity" to show how PBMs reduce drug costs.
Some pharmacists have hailed the move by the FTC, which polices anticompetitive business practices.
The National Community Pharmacists Association called the upcoming vote a "massively significant development for independent pharmacy," according to a recent statement from CEO Douglas Hoey. "Pharmacy benefit managers are the most secretive actors in the healthcare sector, and they've escaped scrutiny for a far too long."
PBMs serve as the middlemen between drug manufacturers, health plans and pharmacies. They've faced scrutiny in recent years over the high cost of prescription drugs and lack of transparency.
One PBM business practice in particular, spread pricing, has raised concerns across the country. Spread pricing is when a PBM reimburses pharmacies one price for a drug but charges the health plan another, driving up profits for PBMs. Pharmacies have complained that sometimes the reimbursement rate from PBMs is lower than the actual cost to acquire the drug.
The issue of spread pricing even made its way to the Supreme Court last year after Arkansas passed a law to curb the practice.
For example, a study commissioned by Ohio's Department of Medicaid found "PBMs billed Ohio $223.7 million more than they reimbursed pharmacies for the same drugs," according to the 2020 Supreme Court case in which PCMA, the PBM lobby, challenged the Arkansas law.
The below-cost reimbursement caused almost two dozen community pharmacies to close in Iowa, according to documents from the case.
The National Community Pharmacists Association is hopeful the study, if approved by commissioners, will lead to significant changes in the industry.
The launch of a new online pharmacy with a big-name backer has underscored the dizzyingly complex world of drugs costs, particularly for consumers.
The Mark Cuban Cost Plus Drug Company said consumers who pay entirely out of pocket and don't use their insurance have found some generic drugs actually are less expensive than under insurance. Cuban, owner of the Dallas Mavericks professional basketball team and host of popular TV show Shark Tank, cuts out the middlemen and sells the drugs at cost plus a 15% markup and pharmacist fee.
A 2019 poll found that one in four Americans struggle to afford their prescription drugs and as many as 29% forgo their medicines at some point due to cost, according to the Kaiser Family Foundation.