Yesterday the Federal Trade Commission released a report detailing pharmacy benefit managers' price gouging over specialty generic drugs, including those for heart disease, cancer and HIV. It says, among other things, that Caremark Rx, Express Scripts, and OptumRx controlled 44 percent of the commercial specialty generic 30-day market and 72 percent of those drugs were marked up more than $1,000 per prescription.
In a statement, NCPA CEO Douglas Hoey said it was "just the latest obvious signal to policymakers that they must pass PBM reform that would include paying for prescriptions based on the cost of the drug plus a transparent pharmacist professional dispensing fee."
"While the Big 3 have consolidated and vertically integrated over the years, they increasingly declare expensive medications to be ‘specialty' to steer patients to a PBM-affiliated specialty pharmacy to the tune of $7.3 billion above the drug cost. They crush their competition by reimbursing their own pharmacies as much as 100 percent more than they reimburse independent pharmacies for the same drug, or more," he said.
During an open meeting yesterday where the FTC discussed the report, NCPA General Counsel Matthew Seiler was one of the speakers encouraging its release.
The report analyzed 51 specialty generic drugs dispensed between 2017 and 2022 for those insured under commercial health plans and Medicare Part D prescription drug plans managed by the big three PBMs. It said they had hiked the prices of some drugs by thousands of percent, including those treating deadly chronic conditions.
The agency found also that they may be steering highly profitable prescriptions to their own affiliated pharmacies, and that those affiliated pharmacies generated over $7.3 billion of dispensing revenue in excess of NADAC.
Hoey said patients would be better served if the so-called specialty drugs were able to be dispensed by their preferred community pharmacy, instead of pushing patients to PBM-owned mail-order pharmacies.
In his remarks before the FTC, Seiler noted that while PBMs say pharmacies can redline contracts and negotiate with them, it is extremely rare for that to be successful.
"Independent pharmacies provide essential health care services to hard working Americans across the country. From communities in Utah to small towns in Maine, every American deserves access to affordable medicine," Seiler said, "and they rely on the FTC to preserve vibrant, competitive, and innovative health care markets that provide the best quality service at the most affordable price."
You can read the FTC's statement on the report's release here, and read the report here. You can read NCPA's statement on the report here.
