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On September 20, 2024, the Federal Trade Commission (FTC) initiated legal proceedings against the top three pharmacy benefit managers (PBMs) in the U.S., alleging their practices have led to inflated insulin prices. The PBMs implicated include CVS Health’s Caremark, Cigna’s Express Scripts, and UnitedHealth’s Optum Rx, which collectively manage 80% of the nation’s prescription drug market.
Functioning on behalf of employers and various government health programs, these PBMs are tasked with negotiating drug prices, handling payments to pharmacies, and determining drug availability and pricing for consumers. The FTC’s complaint, which remains confidential as of now, charges that these PBMs have been engaging in practices that not only distort competition but also adversely affect consumers by pushing higher-cost insulin products that benefit the PBMs financially.
The FTC seeks to enforce measures that would prevent these managers from promoting medications that yield higher profits at the expense of consumer welfare and fair market practices. This action underscores the government’s increasing scrutiny of intermediaries in the healthcare sector whose actions impact drug costs and availability.
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