The Federal Trade Commission is preparing to take legal action against three major U.S. health companies for their role as intermediaries who negotiate prices for essential medications like insulin. These companies, UnitedHealth Group’s Optum Rx, CVS Health’s Caremark, and Cigna’s Express Scripts, are being accused of artificially inflating costs for patients. The suits will focus on the business practices related to the rebates that Pharmacy Benefit Managers (PBMs) broker with drug manufacturers.
The FTC’s investigation into insulin prices not only targets PBMs but also looks into the role of drug manufacturers. The report criticizes the three largest PBMs for manipulating the drug supply chain to benefit themselves at the expense of smaller, independent pharmacies and American patients. The investigation, which began in 2022, revealed that six major PBMs dominated 95% of the prescriptions filled in the U.S., highlighting a concerning level of control over the market.
In response to the impending lawsuits, CVS Caremark and Express Scripts defended their actions. CVS Caremark claimed to have made insulin more affordable for Americans with diabetes while also asserting their commitment to protecting businesses, unions, and patients from rising drug prices. Express Scripts, on the other hand, pointed out that drug prices are set by manufacturers and highlighted their efforts to lower the costs of medications for patients and health plans.
The U.S. healthcare system has faced significant scrutiny over escalating drug prices, with Americans paying significantly more for prescription medications than patients in other developed nations. The Biden administration and Congress have intensified their focus on PBMs, calling for increased transparency into their operations. President Biden’s Inflation Reduction Act, which caps insulin prices for Medicare beneficiaries at $35 per month, demonstrates efforts to address the issue, although the policy does not cover individuals with private insurance.
The upcoming legal action against major U.S. health companies involved in negotiating medication prices shines a light on the complexities of the healthcare system and the challenges faced by patients in accessing affordable treatment. The alleged business practices of PBMs and drug manufacturers have implications for both the industry and consumers, raising questions about the role of intermediaries in determining drug pricing and accessibility. As the investigations continue and the lawsuits unfold, it remains to be seen how the healthcare landscape will evolve to address the pressing issues surrounding medication costs.