The Federal Trade Commission (FTC) released a report finding that OptumRX, Express Scripts, and CVS Caremark Rx are engaged in widespread price gouging, according to Fortune.
The investigation into prescription benefit managers (PBMs), which concluded in 2022, revealed that these companies gained $7.3 billion in revenue from markups.
The report also details the ‘Big 3 PBMs’ pattern of funneling high-cost medication to their respective pharmacies, yielding those pharmacies higher revenue.
“[prescriptions are] marked up more
than $1,000 per prescription were dispensed by the Big 3 PBMs’ affiliated pharmacies compared with unaffiliated pharmacies. Dispensing patterns suggest that the Big 3 PBMs may be steering highly profitable prescriptions to their own affiliated pharmacies (and away from unaffiliated pharmacies),” the report stated.The inflated prices raised costs for millions of Americans suffering from life-threatening conditions, including leukemia, cardiac hypertension, and HIV. Some drugs were sold at four times the acquisition cost.
CVS Caremark
contends that the FTC is pushing an anti-PBM agenda. The company warns that if the current policies continue, drug prices will rise for individuals with medical conditions. Caremark also argues that taxpayers and businesses will bear the brunt of subsidizing employer insurance and government assistance programs.“If we’re going to have an investigation like this, the American people deserve to see the complete story based on all the facts and not just those that support a predetermined narrative,” Caremark said in a statement to Fortune
. “The ‘anti-PBM’ policies the FTC is currently pursuing would only increase U.S. drug costs for American patients, employers, unions, and taxpayers.”OptumRX, a PBM owned by UnitedHealth, also provided a statement to Fortune, asserting that its approach is cost-effective and enables the company to offer a range of services for patients with complex health conditions.
“Optum is lowering the cost of specialty medications, which comprise half of all drug expenditures, and providing clinical expertise, programs, and support for patients with complex and rare conditions,” the statement said.
UnitedHealth has come under scrutiny following the recent death of its CEO, Brian Thompson. The alleged gunman, Luigi Mangione, was taken into custody. Reports indicate that Mangione had a 200-word “manifesto” at the time of his arrest, in which he criticized the American healthcare industry.
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