Reporter: Tami Luhby
Pharmacy benefit managers, which serve as the middlemen between drug makers, insurers and pharmacies, reaped $7.3 billion in revenue from marking up the prices of dozens of specialty generic drugs between 2017 and 2022, the Federal Trade Commission said in an interim report issued Tuesday. The practice came at a time when spending on drugs by patients, employers, insurers and others rose significantly.
The nation’s three largest PBMs – CVS Health’s Caremark, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx – inflated the prices of drugs dispensed at their affiliated pharmacies by hundreds or even thousands of percent, the agency found. The medications include those used to treat heart disease, cancer and HIV, among other conditions.
The PBMs, which are tasked with reducing the cost of drugs for their clients, reimbursed their affiliated pharmacies at a higher rate than unaffiliated pharmacies on nearly every one of the 51 specialty general drugs the agency reviewed.
“Plan sponsors in particular should be aware that they and their members are paying the Big 3 PBMs and their affiliated pharmacies very significant markups over the acquisition costs for critical medications,” the report said... CONTINUE READING
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