From CNBC: 2024-07-10 18:08:13

The Federal Trade Commission plans to sue three large U.S. health companies over their practices as middlemen who negotiate prices for medications such as insulin. The expected targets are UnitedHealth Group’s Optum Rx, CVS Health’s Caremark, and Cigna’s Express Scripts, all connected to health insurers. The lawsuits will focus on business practices related to rebates brokered with drug manufacturers.

CVS Caremark and Express Scripts defended themselves against allegations. CVS Caremark highlighted their efforts to make insulin more affordable for those with diabetes while Express Scripts claimed they work to lower drug costs for patients. Optum Rx did not respond to requests for comment. The FTC declined to comment on the reported lawsuits.

Pharmacy benefit managers (PBMs) play a major role in the U.S. drug supply chain, negotiating rebates with drug manufacturers and creating lists of covered medications for insurers. The FTC has been investigating PBMs since 2022, and the upcoming lawsuits will focus on insulin prices. It remains unclear if drugmakers will be named in the suits, but Eli Lilly, Sanofi, and Novo Nordisk control most of the U.S. insulin market.

A scathing interim report from the FTC accused the three largest PBMs of manipulating the drug supply chain to benefit themselves over smaller pharmacies and patients. Despite PBMs blaming high drug prices on manufacturers and drugmakers pointing to middlemen for forcing list price increases, pressure from the Biden administration and Congress seeks transparency into PBM operations as Americans struggle to afford prescription drugs.

President Joe Biden’s Inflation Reduction Act has capped insulin prices for Medicare beneficiaries at $35 per month, but the policy does not extend to patients with private insurance. The average American pays two to three times more for prescription drugs than patients in other developed nations, contributing to the push for increased PBM transparency.



Read more at CNBC: FTC to sue PBMs over drug prices including insulin, source says