The Federal Commerce Fee introduced right now that it’ll launch an inquiry into the prescription drug intermediary business, requiring the six largest pharmacy profit managers to supply data and information concerning their enterprise practices. The company’s inquiry will scrutinize the influence of vertically built-in pharmacy profit managers on the entry and affordability of pharmaceuticals. As a part of this inquiry, the FTC will ship obligatory orders to CVS Caremark; Specific Scripts, Inc.; OptumRx, Inc.; Humana Inc.; Prime Therapeutics LLC; and MedImpact Healthcare Programs, Inc.
“Though many individuals have by no means heard of pharmacy profit managers, these highly effective middlemen have huge affect over the U.S. prescription drug system,” mentioned Federal Commerce Fee Chair Lina M. Khan. “This research will shine a lightweight on these firms’ practices and their influence on pharmacies, payers, medical doctors, and sufferers.”
The Fee’s inquiry will look at pharmacy profit managers’ function on the heart of the U.S. pharmaceutical system. Pharmacy profit managers are the middlemen who’re employed to barter rebates and costs with drug producers, create drug formularies and surrounding insurance policies, and reimburse pharmacies for sufferers’ prescriptions. The biggest pharmacy advantages managers are actually vertically built-in with the biggest medical health insurance firms and wholly owned mail order and specialty pharmacies.
In these roles, pharmacy profit managers typically have huge affect on which medicine are prescribed to sufferers, which pharmacies sufferers can use, and the way a lot sufferers finally pay on the pharmacy counter. Many of those capabilities rely upon extremely difficult, opaque contractual relationships which can be troublesome or inconceivable to grasp for sufferers and unbiased companies throughout the prescription drug system.
The inquiry is aimed toward shedding gentle on a number of practices which have drawn scrutiny lately together with:
The FTC’s inquiry will construct on the numerous public file developed in response to the request for details about pharmacy advantages managers that the company launched on Feb. 24, 2022. The company has obtained greater than 24,000 public feedback to this point.
The FTC is issuing the orders beneath Part 6(b) of the FTC Act, which authorizes the Fee to conduct research with no particular legislation enforcement function. The businesses could have 90 days from the date they obtain the order to reply.
The Fee voted 5-0 to challenge the Part 6(b) orders and conduct the research of pharmacy advantages managers’ enterprise practices. Chair Lina M. Khan , Commissioner Rebecca Kelly Slaughter, and Commissioner Alvaro Bedoya issued statements. Commissioners Noah Joshua Phillips and Christine S. Wilson issued a joint assertion.