The outcome of the FTC review of PBM practices and its report on needed corrections may be some of the biggest news items this year. As the article below details, the FC has basically dumped as totally outdated nine advocacy letters dated between 2004 and 2014, These letters advocated against proposals to increase regulatory oversight and transparency of PBMs….. no bias there!
So, where is the FTC shining its regulatory spotlights?
The inquiry is aimed at shedding light on numerous practices that have come under industry stakeholder attacks, including—-
· fees and clawbacks charged to network pharmacies
· steering patients towards PBM-owned pharmacies
· potentially unfair audits of network pharmacies
· complicated and opaque methods to determine pharmacy reimbursement
· the prevalence and equity of prior authorizations and other administrative restrictions
· the use of specialty drug lists and surrounding specialty drug policies, and
· how rebates and fees paid by drug manufacturers affect the NET cost of drugs to payers
· no pass-through of rebate savings resulting and higher out-of-pocket costs to patients.
That’s quite a list! Relief on any one of which could have significant consumer impact.
As part of this inquiry, the FTC has sent compulsory orders to CVS Caremark, Express Scripts, OptumRx, Humana, Prime Therapeutics, and MedImpact.
The next phase of the FTC investigation might really be a doozie!
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FTC Withdraws Advocacy for Pharmacy Benefit Managers
The Commission rescinded earlier guidance that was opposed to increased regulatory oversight and transparency of PBMs.
JUL 25 — Claiming that its old policy statements no longer reflect current market dynamics, the Federal Trade Commission has voted to rescind its prior statements of advocacy for pharmacy benefit managers, effectively ending the agency’s previously stated endorsement of PBMs.
According to the FTC, the new statement pulling its advocacy is a response to PBMs’ continued reliance on older FTC advocacy materials that opposed mandatory PBM transparency and disclosure requirements.
It also warns against reliance on the Commission’s prior conclusions, particularly given the FTC’s ongoing study of the PBM industry to update its understanding of the industry and its practices.
