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PBMs have been in the spotlight in recent years, with the U.S.
Congress seeking to increase transparency into the industry’s
operations and their effect on prescription drug prices.
Pharmacists have urged Illinois state lawmakers to enact
legislation banning certain drug pricing practices by PBMs,
which they said hurt local pharmacies. They have testified that
they are being damaged by PBMs through the price of acquiring
drugs wholesale and dispensing them at little or no profit.
During an Illinois House Health Care Availability and
Accessibility Committee hearing, Chad Worz, CEO of the American
Society of Consultant Pharmacists, said if conditions don’t
change, more local pharmacies will be forced to close.
“All we can do is make sure that we throw a life raft to
pharmacies and make sure they can survive until we can figure
out better ways to oversee and bring this industry into some
sort of compliance as it relates to health care,” said Worz.
In a study released this month by the Federal Trade Commission,
it said PBMs hold substantial influence over independent
pharmacies by imposing unfair and harmful contractual terms that
can impact the pharmacies ability to stay in business.
As part of its investigation, the FTC requested documentation
from six of the largest PBMs in the country: CVS Health’s
Caremark, Cigna’s Express Scripts, UnitedHealth’s Optum Rx,
Prime Therapeutics, Humana’s Pharmacy Solutions and MedImpact.
Conner Rose with the Pharmaceutical Care Management Association
said a previous study by the FTC looked favorable on PBMs.
“Specifically PBM ownership of mail-order pharmacies, which that
study demonstrated that PBM ownership of mail order pharmacies
actually do provide value to consumers in the form of lower drug
costs,” said Rose.
Caremark, Express Scripts and Optum Rx alone processed nearly
80% of the over 6 billion prescriptions dispensed by U.S.
pharmacies last year, according to the FTC.
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