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FTC launches investigation into practices of pharmacy benefit managers

The Federal Trade Commission is launching an investigation into the operations of drug benefit managers who control access to prescription drugs for millions of Americans.

The consumer protection agency said on Tuesday it would order the country’s largest PBMs to provide a series of information and documents detailing their operation.

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Pharmacy benefit managers manage prescription drug coverage for large clients, including health insurers and employers who provide coverage. They help decide which drugs should be on a plan’s formulary or on the list of covered drugs. They can also determine where patients will fill their prescriptions.

These companies, the largest of which are run by companies that also operate health insurers, have come under fire from doctors and patients over their formularies and other concerns about drug access.

FTC Chairman Lina M. Khan said in a statement that PBMs have a “tremendous influence” on the nation’s prescription drug system.

“This study will shed light on the practices of these companies and their impact on pharmacies, payers, physicians and patients,” Khan said.

The FTC said it would seek to learn more from PBMs about drugmaker rebates and how they affect formulary design and drug cost.

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The agency said it will also examine “complicated and opaque methods of determining pharmacy reimbursement” and how patients are referred to PBM-owned pharmacies.

The agency will request information from OptumRX, which is part of the UnitedHealth group; CVS Health’s Caremark business and insurer Humana, among others.

A CVS Health spokesperson said the company looks forward to “working cooperatively with the Federal Trade Commission.”

The federal agency said the FTC law allows it to conduct studies without a specific law enforcement purpose, and companies will have 90 days from the date they receive an order to respond.


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