Reforming PBMs: The FTC Takes Legal Action Against Major PBMs Regarding Insulin Pricing

Friday, 20 September 2024, 11:37

PBM reform is at the forefront as the FTC initiates legal action against the three largest pharmacy benefit managers (PBMs) for escalating insulin costs. These actions aim to address long-standing issues with how PBMs negotiate drug prices and manage pharmacy reimbursements, disproportionately impacting patient access to affordable insulin. The scrutiny over PBMs' business practices highlights the urgent need for meaningful reform in the healthcare industry.
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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.


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