The recent decision by the Federal Trade Commission to study the business practices of pharmacy benefit managers (PBMs) is a significant victory for millions of patients and their families, caregivers, and providers. The FTC’s inquiry into these practices will shed light on the complex systems and how PBM practices potentially harm patients.
The role of PBMs has grown substantially – to the detriment of patients. These “middlemen” determine prescription drug access and affordability for most Americans who rely on prescription medicines to maintain their health. Astonishingly, three PBMs are responsible for processing approximately 80 percent of all prescription drug transactions. PBMs control what drugs are covered on formularies, on which tier a medicine is placed on a formulary, what covered medicines cost consumers at the pharmacy counter, which pharmacy counter (or mailbox) consumers must use, all step therapy and prior authorization requirements consumers must meet, and more.
LMDD and more than 100 patient and advocacy groups filed comments with the FTC strongly encouraging the probe. We are looking to Congress for critical oversight and applaud recent efforts with the introduction of The Prescription Pricing for the People Act.