Reforming PBMs: The FTC Takes Legal Action Against Major PBMs Regarding Insulin Pricing
Overview of the FTC's Legal Action
In a critical move towards PBM reform, the FTC has filed legal actions against CVS Health’s Caremark, Cigna’s Express Scripts, and United Health’s Optum Rx. These three PBMs dominate the market, controlling about 80% of prescriptions in the United States.
The Impact of PBMs on Insulin Costs
For years, high insulin costs have burdened patients, with many being forced to ration their medications. The FTC’s investigation seeks to shine a light on how the market power wielded by PBMs impacts both drug pricing and patient access. Experts warn that this monopolistic control has exacerbated the affordability crisis following significant price increases for insulin products over the decades.
Key Findings of the FTC Investigation
- Insulin list prices have more than doubled from 2012 to 2019.
- Negotiations often favor high-rebate drugs over more affordable biosimilars.
- Policy changes are urgently needed to protect patients from escalating costs.
Recommendations for Reform
Experts, including Julie Reed from the Biosimilars Forum, stress the importance of legislative changes that target the practices of PBMs. Suggested reforms aim to prioritize lower-cost biosimilars and ensure more competitive pricing within the marketplace.
This article was prepared using information from open sources in accordance with the principles of Ethical Policy. The editorial team is not responsible for absolute accuracy, as it relies on data from the sources referenced.