National Association of Chain Drug Stores (NACDS)’s Post

Last week, the Federal Trade Commission released an interim report highlighting how the consolidation and vertical integration of the PBM industry have allowed the six largest PBMs to control 95% of U.S. prescriptions, leading to inflated drug costs. The report emphasizes how PBMs steer patients to higher cost drugs when generics or biosimilars are available, and how they require patients to use PBM’s own pharmacies at higher costs.     The FTC’s report highlights a need for increased PBM transparency and accountability which USI provides to clients through Clear Options and Clear Guard. By facilitating PBM competition and oversight, USI helps plan sponsors ensure they are receiving optimal pharmacy contract terms, whether they are looking to stay with their incumbent PBM or switch. Oh yea....and then there's that J&J lawsuit and Fiduciary responsibility.

Hopefully today's Federal Trade Commission "interim" report will help Congress get #PBM reform over the finish line this year. Report illustrates how "PBMs wield enormous power over patients’ ability to access and afford their prescription drugs, allowing PBMs to significantly influence what drugs are available and at what price." It also quantifies how "PBMs are highly concentrated and vertically integrated with the nation’s largest health insurers and specialty and retail pharmacies." * PBMs oversee critical decisions about access to and affordability of life-saving medications, without transparency or accountability to the public. * Vertically integrated PBMs appear to have the ability and incentive to prefer their own affiliated businesses, creating conflicts of interest that can disadvantage unaffiliated pharmacies and increase prescription drug costs. * The top three PBMs processed nearly 80% of 6.6 billion prescriptions in 2023 & the top six PBMs processed more than 90%. * Pharmacies affiliated with the three largest PBMs now account for nearly 70% of all specialty drug revenue. https://lnkd.in/e9a-MHMF

Really great share by Sana's PBM, SmithRx, highlighting the importance of transparency and reform in the Rx space. How do you know if you are truly using a completely transparent PBM? - Disclosure of rebates and "discounts" - Clear pricing strategy - Accessible information and plan data - Disclosure of independent audits - Contract transparency Leveraging a transparent pharmacy strategy is no longer a commodity for large self funded health plans. It is a necessary lever in healthcare that otherwise costs your clients tens of thousands, if not hundreds, in annual Rx spending. #benefits #healthcare #innovation #pharmacy #pbm

The FTC has released an interim report uncovering crucial insights on Pharmacy Benefit Managers (PBMs) and their profound influence on prescription drug accessibility and affordability in the U.S. Key takeaways reveal: - The top six PBMs collectively manage nearly 95% of all prescriptions, with the leading three controlling approximately 80%, illustrating significant market concentration and vertical integration. - This dominant position empowers PBMs to wield extensive control over drug availability, pricing, and patients' pharmacy choices. Examples of PBM price gouging and keeping huge rebates, Stelara cost to employer $300,000 rebates to PBM $181,000 Eliquis cost to employer $6,000 rebates to PBM of $2,652 Trulicity cost to employer $1,819 rebates to PBM of $1,100 Wegovy cost to employer $225 rebates to PBM of $416 Ozempic cost to employer $150 rebate to PBM of $543 The above is recent analysis i did on one of these pharmacy benefit managers but i see it across the board. Want to affect change listen to someone who is fighting in the trenches. If you want proof i am happy to share my analysis this is happening and some are trying to affect positive change. Who has your 6 when it comes to pharmacy benefit managers? #FTC #PBMs #Pharmacy #Healthcare #PrescriptionDrugs #Affordability #Accessibility #PatientCare

In a recent lawsuit, Johnson & Johnson's (J&J) prescription drug pricing practices were brought into question, revealing the pitfalls of discount-focused PBM strategies. Turns out they were overpaying for prescription drugs by margins of over 805%. 💥 This isn't just a problem for J&J; it's a widespread issue among companies that contract with discount-driven PBMs like the Big Three. With a cost-focused PBM partner like SmithRx, we prioritize lowering overall costs rather than chasing discounts and rebates. 🤝 Learn more about how a cost-based approach can benefit your organization: https://lnkd.in/gkRXCTwT #johnsonandjohnson #pbms #employeebenefits #transparency #smithrx

I am not commenting on the value of PBMs, but this paper by the FTC provides excellent information on the industry's status, which entity owns which PBM, and lots of other helpful info. "Over the past 20 years, pharmacy benefit services have become increasingly concentrated. In 2004, the top three PBMs served a combined 190 million people and managed 52 percent of prescription drug claims.13 Today, the top three PBMs—CVS Caremark, Express Scripts, and OptumRx (together, the “Big 3”)—manage 79 percent of prescription drug claims for approximately 270 million people.14 With the next three largest PBMs—Humana Pharmacy Solutions, MedImpact, and Prime—the six largest PBMs (together, the “Big 6”) now manage 94 percent of prescription drug claims in the United States." https://lnkd.in/eYH3VJmq

The Federal Trade Commission (FTC) has released an interim report on its investigation into pharmacy benefit managers (PBMs), revealing concerning practices that may harm patients, pharmacies, and employers. The report highlights issues such as PBMs steering patients to affiliated pharmacies, potentially limiting patient choice and raising costs. The investigation found that PBMs often engage in complex and opaque contracting practices, making it difficult for employers to understand the true costs of prescription drugs. Additionally, PBMs were found to use their market power to squeeze independent pharmacies through unfavorable reimbursement rates and fees. The FTC's report also raises concerns about vertical integration in the healthcare industry, with PBMs increasingly owning or being owned by insurance companies and pharmacies. This integration may create conflicts of interest and reduce competition. The interim findings suggest that PBM practices could lead to higher drug prices, reduced access to medications, and decreased competition in the pharmaceutical market. The FTC plans to continue its investigation and may consider policy recommendations or enforcement actions to address these issues. #healthcare #PBMs #BigPharma #HealthcareCosts #FTC #HealthcareCosts https://lnkd.in/eHBa2GjH

"As a result of this high degree of consolidation and vertical integration, the leading PBMs now exercise significant power over Americans’ ability to access and afford their prescription drugs." Pharmacy benefit managers, or "PBMs," are coming under increased scrutiny by the FTC and in legal proceedings. If you aren't familiar with these middleman organizations that exert control over drug prices, you should definitely study up. This interim preliminary report by the FTC is an excellent primer on how these often unknown entities have amassed enormous power to define pricing and access to life-saving medicine. https://lnkd.in/ezEzMagN

The Federal Trade Commission (FTC) has just released an interim staff report shedding light on the impact of prescription drug middlemen, or pharmacy benefit managers (PBMs), on drug prices and patient access to medications. The report highlights key findings and areas of concern that are crucial for healthcare providers, patients, and the entire pharmaceutical industry. At Wellyfe, we applaud the FTC’s efforts to bring transparency and accountability to the role of PBMs in the healthcare system. This report underscores the need for reforms to ensure that patients receive the most cost-effective and clinically appropriate medications without undue influence from intermediaries. Key Takeaways from the FTC Report: 🔍 Transparency: The need for greater transparency in PBM practices to prevent hidden costs and conflicts of interest. 📉 Cost Savings: Identifying how PBM practices may contribute to higher drug prices and exploring ways to pass savings directly to patients. ⚖️ Regulatory Oversight: Enhancing regulatory oversight to protect consumers and promote fair competition in the pharmaceutical market. At Wellyfe, our mission is to revolutionize pharmacy benefit management by prioritizing patient care, cost savings, and transparency. We are committed to: ✅ Direct Pharmacy Care (DPC): Providing personalized care and medication management that puts patients and communities. ✅ Transparent Pricing: Offering clear and straightforward pricing models that eliminate hidden fees and maximize savings. ✅ Innovative Solutions: Implementing advanced technology and data analytics to optimize pharmacy operations and improve patient outcomes. As we continue to navigate the complexities of the healthcare landscape, we remain dedicated to advocating for policies and practices that benefit patients, healthcare providers, and the broader community. The FTC’s report is a significant step toward a more equitable and efficient healthcare system. Join us in our commitment to transforming pharmacy benefit management and ensuring that every patient has access to affordable, high-quality medications. Read the full FTC report here: https://lnkd.in/e9a-MHMF #Healthcare #Pharmacy #PBM #Wellyfe #PatientCare #Transparency #CostSavings #FTC #PharmacyBenefitManagement

🏥 The Federal Trade Commission (FTC) has criticized the business practices of pharmacy benefit managers (PBMs) and highlighted their role in inflating prescription drug prices. However, #drugmakers are also at fault for the high costs of medications. 💡 Insight - PBMs like Express Scripts, Caremark, and Optum Rx control 80% of U.S. prescriptions, using tactics that raise drug prices. Meanwhile, drugmakers set high prices and increase them over time, forcing patients to pay more or abandon treatment. Both sides blame each other, but the sanctimonious finger-pointing hasn't resolved the affordability issue. ❓ Key questions - How can regulatory measures like the #DRUGAct and the #MedicareDrugPriceNegotiationProgram effectively address these issues? What additional reforms are needed to ensure fair pricing and access to medications? #Pharma #PBMs #DrugPricing #HealthcareReform #FTC #PatientAccess