Lawmakers are seeking to pledge to complete the investigation into the high prescription drug cost schemes.
US Senator Cindy Hyde-Smith (R-MS) is among seven senators who have signed a letter at Federal Trade Commission (FTC) Linda Khan asking her to commit to a timeline for her investigation into Pharmacy Benefit Managers (PBMs), an agency probe launched in June following pressure from Congress over the issues insulin price.
Hyde-Smith joined the bipartisan effort to ensure the FTC completes the investigation into PBMs for potential market manipulation tactics and other anti-competitive practices that drive up the cost of prescription drugs.
“As you know, PBMs operate with little or no transparency, which makes it very difficult, if not impossible, to understand the flow of money in the prescription drug market and how PBMs determine prescription drug prices. “, wrote the senators. “Recent consolidations between PBMs, insurers and other healthcare entities have resulted in vertical integration in which a small number of companies now manage the vast majority of prescription drug benefits. CVS/Caremark, OptumRx and Express Scripts control around 75% of the PBM market and are owned by insurers Aetna, United Healthcare and Cigna respectively.
The group of lawmakers expressed support for legislation that would require the FTC to conduct a study and report to Congress within a year on the effects of consolidation and potentially anti-competitive behavior that could impact prices prescription drugs.
“A few of the provisions to be considered in the report include whether PBMs charge certain payers a higher price than competing pharmacies or refer patients to pharmacies in which PBM has an equity interest, whether PBMs are using formulary models to reduce the market share of low-cost prescription drugs, and whether more information about the roles of intermediaries in the healthcare market would benefit consumers,” lawmakers said. “In 2021, This legislation has been unanimously approved by the Judiciary Committee and awaits a decision by the full Senate.”
The senators said there is broad support for reviewing PBMs and determining whether they force Americans to pay higher prices for prescription drugs.
“That’s why we support the FTC’s decision to conduct a PBM study,” the senators continued. “We constantly hear stories about rising drug prices. A timely study of the business practices of these intermediaries would provide transparency, insight into potential competitive harms and inform possible legislative action. With the FTC’s action on June 7, 2022, the study has broad support and interest in reviewing its findings in a timely manner. To ensure the usefulness of Study 6(b), we urge the FTC to release the report within one year of its publication.