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ACR Applauds FTC Decision to Investigate PBM's

  • ACR Press Release
Jun 13, 2022 3:44 pm

The American College of Rheumatology applauds the Federal Trade Commission’s decision to investigate the business practices of pharmacy benefit managers (PBMs), which continue to increase PBM profit margins while placing the burden of skyrocketing drug costs on America’s most vulnerable patients, including those living with chronic and severe rheumatic diseases.

This welcomed news follows sustained calls from the rheumatology community for greater oversight over the insurance middlemen who drive up drug costs for our patients. The FTC investigation announced today is a critical step toward greater transparency and oversight over PBMs’ opaque business practices, as well as the enactment of meaningful drug pricing reforms that will reduce costs and expand access to important therapies for our patients.

While PBMs were originally conceived to help manage the complexities of prescription drug benefits, they have since become massive, consolidated, profit-driven enterprises that exercise immense control over our patients’ access to needed treatments. Their business practices are detrimental to policy efforts to curb the high cost of prescription drugs.

The FTC announced today it will examine the role of PBMs, which are hired by insurers to negotiate rebates and fees with drug manufacturers as well as develop drug formularies that impact reimbursement to pharmacies for patient medications. Citing “complicated and opaque methods to determine pharmacy reimbursement, prevalence of prior authorizations and other administrative restrictions and the use of specialty drug lists surrounding specialty drug policies” as some areas of investigation, the FTC noted it has received more than 24,000 public comments to date regarding the potential investigation of PBMs.

The author has no conflicts of interest to disclose related to this subject

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