FTC Commissioner Bedoya calls out PBM games

NCPA September 22, 2022

On Thursday, FTC Commissioner Alvaro M. Bedoya delivered remarks in Minneapolis calling out the unfair games PBMs play. Bedoya cited an example where a pediatric cancer patient in West Virginia was denied readily available, behind-the-counter medication as the PBM insisted that the medicine can only be dispensed by the PBM’s own mail-order specialty pharmacy. The PBM then told the family to go home and wait two weeks to receive the medication via mail order, according to written remarks from Bedoya. He added that this is a product of vertical integration, which took the pharmacy benefit landscape from about 39 companies including pharmacies, PBMs, and insurers down to just three main PBMs. “And so today, when most people fill a prescription, just one of three entities mediates what medicine they get, what they pay for it, and how they will get it – and that corporate entity makes money by making sure that prescription is filled by its own pharmacy,” Bedoya said. “Even, apparently, when it is cancer medicine. And even, apparently, when doing that will force a child to wait for two weeks.” In closing, Bedoya said, “… Antitrust is about: your groceries, your prescriptions, your paycheck. I want to make sure the commission is helping the people who need it the most.” NCPA staff attended the forum.

A health care panel discussion featured community pharmacists Jessica Astrup Ehret (Owner, Astrup Cos.) and Steve Simenson (treasurer and managing partner, Goodrich Pharmacies), in addition to Tracy Jones of the AIDS Task Force of Greater Cleveland and John Farina of the AIDS Healthcare Foundation. Astrup Ehret discussed the many pitfalls of PBM’s “take-it-or-leave-it” contracts. Simenson discussed how PBMs under-reimburse drugs and how community pharmacies are negatively affected by vertical integration. Farina and Jones discussed PBMs negatively affect access to AIDS medication. Minnesota Attorney General Keith Ellison provided keynote remarks along with Bedoya.