WASHINGTON (February 15, 2022) AIDS Healthcare Foundation (AHF) today welcomed the U.S. Federal Trade Commission’s announcement that it will vote to study the anti-competitive practices of the Pharmacy Benefit Manager (PBM) industry that plague independent specialty pharmacies. See: FTC Announces Tentative Agenda for February 17 Open Commission Meeting | Federal Trade Commission.
Pharmacy Benefit Managers (PBMs), which began as a way to help patients access drugs they need, have spiraled out of control, with just three PBMs—CVS Caremark, OptumRx and Express Scripts—now controlling 75% of the US market
AHF Pharmacies are vital to AHF’s mission to provide cutting edge medicine and advocacy regardless of the ability to pay. Our pharmacists and staff work tirelessly with AHF medical providers to keep people living with HIV healthy and virally suppressed. PBMs interfere with that model of care. PBMs are parasitic middlemen that bring no value to patients, creating pharmacy deserts across the United States, as they steadily squeeze specialty pharmacies, preventing patients insured by their parent companies from using specialized pharmacies like AHF’s. They also engage in “take or leave it” contracts that force “claw back’ payments known cryptically as “direct and indirect renumeration” (DIR) fees. Three PBMs, owned by for-profit insurance companies, control about 70 percent of the prescription drug market in the U.S.
“Our David and Goliath battle between independent and smaller pharmacies and PBMs, particularly, the big three: CVS Caremark, OptumRx and Express Scripts, has gotten so out of hand that we need help and protections for struggling smaller and independent pharmacies,” said Michael Weinstein, president of AHF. “And as clawbacks affect consumers in all 50 states, we believe it’s appropriate to ask the federal government to intervene to protect those pharmacies that protest and speak out against PBM abuses from possible retaliation, blacklisting or exclusion from the PBMs’ networks.”
The FTC said it will vote on February 17 on whether to make PBMs hand over information on contracts, reimbursements, “and other practices affecting drug prices, including those practices that may disadvantage independent or specialty pharmacies.”
“There’s a new sheriff in town,” said Scott Carruthers, AHF’s chief pharmacy officer. “The commission must use all lawful tools to rein in these out-of-control companies that prey on patients and undermine patient care.”
A concise 3-minute PBM explainer video neatly distills the complex issue into easily understood language and imagery can be found here: (direct YouTube link).