In stark terms, the Federal Trade Commission found in a report released Tuesday that pharmacy benefit managers — the opaque middlemen in the pharmaceutical supply chain — wield such “enormous power” that these companies can affect the ability of many Americans to access and afford their medicines.
The agency noted that the three largest PBMs processed nearly 80% of the roughly 6.6 billion prescriptions dispensed by U.S. pharmacies in 2023. And the six largest PBMs — Caremark Rx, Express Scripts, OptumRx, Humana Pharmacy Solutions, Prime Therapeutics, and MedImpact Healthcare Systems — processed more than 90% of the prescriptions.
Moreover, the FTC found the prescription drug market is “highly concentrated” because the largest PBMs are owned by insurers and, in turn, own specialty, mail order, or retail pharmacies. The agency noted these arrangements give PBMs “substantial influence over independent pharmacies by imposing unfair, arbitrary, and harmful contractual terms” that can put them out of business.
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