www.modernhealthcare.com Open in urlscan Pro
2606:4700::6811:2651  Public Scan

Form analysis
3 forms found in the DOM

GET /search

<form action="/search" method="get" id="views-exposed-form-search-autocomplete-page" accept-charset="UTF-8">
  <div class="form--inline clearfix">
    <div class="js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-search-phrase form-item-search-phrase form-no-label">
      <span class="field-prefix">
        <div class="elastic-autocomplete-mobile-search-icon-wrapper"><a class="elastic-autocomplete-mobile-search-icon" href="#"><i class="fa fa-search omnitrack" aria-hidden="true"></i></a></div>
        <div class="elastic-autocomplete-field-wrapper">
          <input class="elastic-autocomplete-input form-autocomplete form-text ui-autocomplete-input" placeholder="Search" data-drupal-selector="edit-search-phrase" data-autocomplete-path="/admin/view_content/search_autocomplete" type="text"
            id="edit-search-phrase" name="search_phrase" value="" size="30" maxlength="128" data-once="autocomplete" autocomplete="off">
          <span class="field-suffix"><a href="#" class="elastic-autocomplete-search-icon"></a></span>
        </div>
      </span>
    </div>
    <input data-drupal-selector="edit-field-emphasis-image" type="hidden" name="field_emphasis_image" value="">
    <input data-drupal-selector="edit-sort-by" type="hidden" name="sort_by" value="search_api_relevance">
    <div data-drupal-selector="edit-actions" class="form-actions js-form-wrapper form-wrapper" id="edit-actions"><input data-drupal-selector="edit-submit-search-autocomplete" type="submit" id="edit-submit-search-autocomplete" value="Search"
        class="button js-form-submit form-submit">
    </div>
  </div>
</form>

POST /politics-policy/pharmacy-benefit-managers-pbms-higher-prices-ftc-cvs-cigna-unitehealth

<form class="newsletter-widget-signup-form--1" data-drupal-selector="newsletter-widget-signup-form-1" action="/politics-policy/pharmacy-benefit-managers-pbms-higher-prices-ftc-cvs-cigna-unitehealth" method="post" id="newsletter-widget-signup-form-1"
  accept-charset="UTF-8">
  <div class="js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-newsletter-email form-item-newsletter-email">
    <label for="edit-newsletter-email">Email Address</label>
    <input class="form-email form-text" data-drupal-selector="edit-newsletter-email" type="text" id="edit-newsletter-email" name="newsletter_email" value="" size="60" maxlength="128">
    <span class="field-suffix">
      <div class="result_message newsletter_error"></div>
    </span>
  </div>
  <input class="omnitrack button js-form-submit form-submit" data-omnilink="inline-modernhealthcarealert" data-omnilocation="newsletter-component" data-omnievent="event10" data-drupal-selector="edit-newsletter-button" data-disable-refocus="true"
    type="submit" id="edit-newsletter-button" name="op" value="Submit" data-once="drupal-ajax">
  <div data-drupal-selector="edit-captcha" class="captcha"><input data-drupal-selector="edit-captcha-sid" type="hidden" name="captcha_sid" value="253256001">
    <input data-drupal-selector="edit-captcha-token" type="hidden" name="captcha_token" value="tE6NXeFyhQ8jOCVnuTCq-z1pD4aGPbGzRj1YWNTcHoo">
    <input data-drupal-selector="edit-captcha-response" type="hidden" name="captcha_response" value="Google no captcha">
    <div class="g-recaptcha" data-sitekey="6LddM-oZAAAAAL3-3V972vvwLyB_bHrM-eJrs5w7" data-theme="light" data-type="image"></div><input data-drupal-selector="edit-captcha-cacheable" type="hidden" name="captcha_cacheable" value="1">
  </div>
  <input data-drupal-selector="edit-newsletter-parameters" type="hidden" name="newsletter_parameters"
    value="inline-modernhealthcarealert Submit Modern Healthcare Alert https://home.modernhealthcare.com/clickshare/extAPI1ChangeServicesAdd.do selection.AlertNewsletter=Y">
  <input autocomplete="off" data-drupal-selector="form-twx9jy2mltz3jcgxmbq2jeu4entg8qc8ub-pznb7yys" type="hidden" name="form_build_id" value="form-twX9jY2mLTZ3jcgxMBq2jeU4eNTg8QC8UB-pznB7yys">
  <input data-drupal-selector="edit-newsletter-widget-signup-form-1" type="hidden" name="form_id" value="newsletter_widget_signup_form _1">
  <input data-drupal-selector="edit-field-emphasis-image" type="hidden" name="field_emphasis_image" value="">
</form>

POST /politics-policy/pharmacy-benefit-managers-pbms-higher-prices-ftc-cvs-cigna-unitehealth

<form class="newsletter-signup-form" data-drupal-selector="newsletter-signup-form" action="/politics-policy/pharmacy-benefit-managers-pbms-higher-prices-ftc-cvs-cigna-unitehealth" method="post" id="newsletter-signup-form" accept-charset="UTF-8">
  <div class="js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-newsletter-email form-item-newsletter-email form-no-label">
    <input class="form-email form-text" placeholder="Enter Business Email" data-drupal-selector="edit-newsletter-email" type="text" id="edit-newsletter-email--2" name="newsletter_email" value="" size="60" maxlength="128">
  </div>
  <input class="omnitrack button js-form-submit form-submit" data-omnilink="footer" data-omnilocation="newsletter-component" data-omnievent="event10" data-drupal-selector="edit-newsletter-button" type="submit" id="edit-newsletter-button--2" name="op"
    value="Sign Up">
  <input data-drupal-selector="edit-newsletter-parameters" type="hidden" name="newsletter_parameters" value="Sign Up /user-dashboard &amp;view=newsletter-page footer 1">
  <input autocomplete="off" data-drupal-selector="form-eelhar8c4i6zyzizmr6j2yxbctmp21j3dmhfqxbvsq8" type="hidden" name="form_build_id" value="form-eElhAR8C4I6ZyziZmr6j2yXBCtmP21J3dmhfqxBvSq8">
  <input data-drupal-selector="edit-newsletter-signup-form" type="hidden" name="form_id" value="newsletter_signup_form">
  <input data-drupal-selector="edit-field-emphasis-image" type="hidden" name="field_emphasis_image" value="">
</form>

Text Content

Menu
Menu
 * News
 * Blogs
 * Opinion
 * Events & Awards
 * Multimedia
 * Data & Insights
 * Newsletters
 * Contact Us
 * Advertise
 * Media Kit
 * Jobs
 * People on the Move
 * Reprints & Licensing
 * Sponsored Content


News
 * Current News
 * Providers
 * Insurance
 * Government
 * Finance
 * Technology
 * Safety & Quality
 * Digital Health
 * Transformation
   * Patients
   * Operations
   * Care Delivery
   * Payment
 * ESG
 * People
 * Regional News
   * Midwest
   * Northeast
   * South
   * West
 * Digital Edition (Web Version)

Blogs
 * AI
 * Deals
 * Layoff Tracker
 * Sponsored Content: Vital Signs Blog

Opinion
 * Letters
 * From the Editor

Events & Awards
 * Awards
   * Nominate/Eligibility
   * 100 Most Influential People
   * 50 Most Influential Clinical Executives
   * 40 Under 40
   * Best Places to Work in Healthcare
   * Healthcare Marketing Impact Awards
   * Innovators Awards
   * Diversity Leaders
   * Women Leaders
 * Conferences
   * Digital Health Summit
   * Women Leaders in Healthcare Conference
   * Leadership Symposium
   * Health Equity Conference
   * Workforce Summit
   * Healthcare of the Future Conference
 * Galas
   * Best Places to Work Awards Gala
   * Diversity Leaders Gala
 * Virtual Briefings
   * - Future of Staffing
   * - Health Equity & Environmental Sustainability
   * - Hospital of the Future
   * - Financial Resiliency
   * - Value Based Care
   * - Looking Ahead to 2025
 * Webinars

Multimedia
 * Podcast - Beyond the Byline
 * Sponsored Podcast - Healthcare Insider
 * Sponsored Video Series - One on One
 * Sponsored Video Series - Checking In with Dan Peres

Data & Insights
 * Data & Insights Home
 * Hospital Financials
 * Staffing & Compensation
 * Quality & Safety
 * Mergers & Acquisitions
 * Skilled Nursing Facilities
 * Data Archive
 * Resource Guide: By the Numbers
 * Surveys
 * Data Points

Skip to main content
Register now for the Women Leaders in Healthcare Conference
Limited time offer of $599 with code MHWL24-BREAKING
Close
Subscribe
 * Login
 * My Account
 * Logout
 * Register For Free
 * Subscribe

 * News
    * Current News
    * Providers
    * Insurance
    * Government
    * Finance
    * Technology
    * Safety & Quality
    * Digital Health
    * Transformation
    * ESG
    * People
    * Regional News
    * Digital Edition (Web Version)
   
   Patients Operations Care Delivery Payment
   
   Midwest Northeast South West

 * Blogs
    * AI
    * Deals
    * Layoff Tracker
    * Sponsored Content: Vital Signs Blog
   
   
 * Opinion
    * Letters
    * From the Editor
   
   
 * Events & Awards
    * Awards
    * Conferences
    * Galas
    * Virtual Briefings
    * Webinars
   
   Nominate/Eligibility 100 Most Influential People 50 Most Influential Clinical
   Executives 40 Under 40 Best Places to Work in Healthcare Healthcare Marketing
   Impact Awards Innovators Awards
   Diversity Leaders Women Leaders
   
   Digital Health Summit Women Leaders in Healthcare Conference Leadership
   Symposium Health Equity Conference Workforce Summit Healthcare of the Future
   Conference
   
   Best Places to Work Awards Gala Diversity Leaders Gala
   
   - Future of Staffing - Health Equity & Environmental Sustainability -
   Hospital of the Future - Financial Resiliency - Value Based Care - Looking
   Ahead to 2025

 * Multimedia
    * Podcast - Beyond the Byline
    * Sponsored Podcast - Healthcare Insider
    * Sponsored Video Series - One on One
    * Sponsored Video Series - Checking In with Dan Peres
   
   
 * Data & Insights
    * Data & Insights Home
    * Hospital Financials
    * Staffing & Compensation
    * Quality & Safety
    * Mergers & Acquisitions
    * Skilled Nursing Facilities
    * Data Archive
    * Resource Guide: By the Numbers
    * Surveys
    * Data Points
   
   
 * Newsletters
 * MORE+
    * Contact Us
    * Advertise
    * Media Kit
    * Jobs
    * People on the Move
    * Reprints & Licensing
    * Sponsored Content
   
   



MENU
Breadcrumb
 1. Home
 2. Politics & Policy



July 09, 2024 09:25 AM 29 minutes ago


PBMS PAY HIGHER PRICES TO THEIR OWN PHARMACIES, FTC SAYS

Leah Nylen and John Tozzi, Bloomberg
 * Tweet
 * Share
 * Share
 * Email
 * 
 * More
   

Reprints Print
MH Illustration


Drug middlemen paid their own mail-order pharmacies as much as 200 times more
than the price at rival pharmacies for commonly prescribed cancer drugs,
allowing them to bring in at least $1 billion in excess revenue and potentially
raising the costs to patients, the US Federal Trade Commission found in an
interim study.

Pharmacy benefit managers — the middlemen that negotiate with drugmakers and
manage prescription plans for employers and health insurers — influence what
drugs are available and at what cost. Years of dealmaking have wrapped them into
much larger healthcare enterprises that the FTC says exert “significant control
over which drugs are available, at what price, and which pharmacies” patients
can go to.




LET'S MAKE A DEAL

Follow the latest in mergers, acquisitions and partnerships.
CLICK HERE

Consolidating with health insurers, pharmacies and other medical businesses lets
them favor affiliated businesses under their own corporate parents, the agency
said. 



Today the six largest PBMs – which include units of CVS Health Corp., Cigna
Group and UnitedHealth Group Inc. – account for 95% of US prescriptions, the
agency found. 




PRESSURE ON INDUSTRY

Pharmacy benefit managers have attracted growing attention in Washington, and
the FTC’s study adds to pressure on the industry. Drugmakers have long accused
PBMs of pushing up medication costs. Both employer groups that fund prescription
benefits and independent pharmacies that get paid by PBMs have criticized them.
Lawmakers are weighing new restrictions on PBMs, and some states have enacted
reforms.

The FTC described how PBMs “steer” patients to their own dispensaries including
mail-order and specialty businesses, to “advantage their own pharmacies while
excluding rivals.” It cited internal emails where executives at top pharmacy
benefit managers noted client “concerns” about the pricing discrepancy on common
drugs and strategized about how to manage the “optics.”



In one internal communication cited by the FTC, an unidentified executive noted
that patients could get a commonly prescribed treatment for leukemia, a generic
version of Novartis AG’s Gleevec, for $97 at Costco Wholesale Corp., while the
company’s own mail-order pharmacy charged $19,200. The agency didn’t identify
which company that message was from.


OPTICS ‘NOT GOOD’

“We’ve created plan designs to aggressively steer customers to home delivery
where the drug cost is ~200 higher,” the executive wrote. “The optics are not
good and must be addressed.”

The FTC estimated that those increased reimbursement rates for two drugs led to
$1.6 billion in excess revenue for pharmacies affiliated with the three largest
PBMs between 2020 and 2022.

The agency also flagged concerns over how PBMs have restructured their entities
that negotiate rebates with drugmakers, creating new corporate units for that
job and moving some of them overseas. These entities, known as group purchasing
organizations, can generate new fees and rebates from drugmakers that aren’t
passed on to the PBM’s ultimate client.

The FTC opened the study into the market in 2022, seeking a wide swath of
information on what is widely considered one of healthcare’s most opaque
sectors. As part of the study, the FTC sought information from the six largest
companies including CVS, Cigna’s Express Scripts, UnitedHealth’s Optum, Humana
Inc., Prime Therapeutics LLC and MedImpact Healthcare Systems Inc.


‘ROOT CAUSE’

Critics say the PBMs operate in obscure ways, making money from health plan
clients, rebates and fees collected from drugmakers. The PBM industry says it
lowers drug prices and has blamed drugmakers as the “root cause” of prescription
drug costs.

The FTC said in its interim report that it would continue to investigate as
several of the companies it subpoenaed had yet to fully turn over documents.

The agency’s commissioners voted 4-1 to issue the interim report, with
Republican Commissioner Melissa Holyoak dissenting. In a separate statement,
Holyoak faulted the FTC for a lack of empirical analysis on how PBM behavior has
affected the prices that patients pay for drugs.

“Relying upon two examples, without any evidence (empirical or otherwise) that
demonstrates they are representative, is not a substitute for rigorous
analysis,” she wrote.

© 2024 Bloomberg L.P.

RELATED ARTICLES

How PBM legislation would transform the industry
Key senators seek quick action to revive PBM bills
State AGs call on Congress to pass PBM legislation
Letter
to the
Editor

Send us a letter

Have an opinion about this story? Click here to submit a Letter to the Editor,
and we may publish it in print.

Recommended for You
The gun violence research that's about to change hospitals
Massachusetts targets REITs after Steward's bankruptcy

Most Popular

1
The gun violence research that's about to change hospitals
2
Labor, reimbursement rates hit health system credit ratings
3
Private equity interest in digital health heats up: Rock Health
4
How the Supreme Court’s regulation ruling will change healthcare
5
HarmonyCares nets $200M in new funding


Sponsored Content


MODERN HEALTHCARE ALERT: SIGN UP FOR THIS BREAKING NEWS EMAIL TO BE KEPT IN THE
LOOP AS URGENT HEALTHCARE BUSINESS NEWS UNFOLDS.

Email Address




Get Newsletters

Sign up for enewsletters and alerts to receive breaking news and in-depth
coverage of healthcare events and trends, as they happen, right to your inbox.


Subscribe Today


MH magazine offers content that sheds light on healthcare leaders’ complex
choices and touch points—from strategy, governance, leadership development and
finance to operations, clinical care, and marketing.

Subscribe
Connect with Us
 * LinkedIn
 * Twitter
 * Facebook
 * RSS

Our Mission

Modern Healthcare empowers industry leaders to succeed by providing unbiased
reporting of the news, insights, analysis and data.



Contact Us

(877) 812-1581

Email us

 

Resources
 * Contact Us
 * Help Center
 * Advertise with Us
 * Ad Choices
 * Sitemap

Editorial Dept
 * Submission Guidelines
 * Code of Ethics
 * Awards
 * About Us

Legal
 * Terms and Conditions
 * Privacy Policy
 * Privacy Request




Copyright © 1996-2024. Crain Communications, Inc. All Rights Reserved.

Our site uses cookies and related technologies, as described in our 
Datenschutzerklärung, for purposes that may include site operation, analytics,
enhanced user experience, or advertising. You may choose to consent to our use
of these technologies or manage your own preferences.
Akzeptieren Ablehnen Einstellungen verwalten



Close





Already subscribed? LoginLogin


GET FREE ACCESS NOW!

Create your free account to continue reading.

Subscribe TodaySubscribe TodayRegister for FreeRegister for Free

View all subscription optionsView all subscription options

or

Go to homepageGo to homepage

Already subscribed? LoginLogin

View all subscription optionsView all subscription options

Go to homepageGo to homepage