Showing archive for: “Insurance & Financing in Health Care”
One Split Doesn’t Fit All: What CVS’ Breakup Really Says About PBM Reform
CVS Health plans to split in two, but its pharmacy benefit manager would still own a pharmacy business. That complicates any attempt to cast the breakup as an endorsement of laws banning such ownership. CVS wants to separate some services and keep others together. Should lawmakers let companies and their customers test those choices—or make ... One Split Doesn’t Fit All: What CVS’ Breakup Really Says About PBM Reform
Bad Medicine: Why Breaking Up Big Health Care Could Make It Worse
Washington has found its latest villain: “Big Medicine.” The proposed fix? Break it up and hope the pieces behave better than the whole. Americans have real reasons to be frustrated about high health care costs, and large conglomerates rank somewhere between unpopular and reviled—roughly where Microsoft’s “Clippy” sat in the 1990s. So it’s no surprise ... Bad Medicine: Why Breaking Up Big Health Care Could Make It Worse
Section 5 Soup: The Still-Secret Recipe to the FTC’s PBM Case
The Federal Trade Commission (FTC) just announced a “landmark” settlement with one of the nation’s largest pharmacy benefit managers (PBMs). The problem is that it doesn’t actually end the PBM case—and it raises as many questions as it answers. In its settlement with Express Scripts Inc. (ESI) and its affiliated entities, the agency says the ... Section 5 Soup: The Still-Secret Recipe to the FTC’s PBM Case
Borrowed Prices: Pharmaceuticals and the American Tab
The Centers for Medicare & Medicaid Services (CMS) has proposed two sweeping Innovation Center models—the Global Benchmark for Efficient Drug Pricing Model (GLOBE) and the Guarding U.S. Medicare Against Rising Drug Costs Model (GUARD)—that would tie Medicare drug payments to prices set by foreign governments. Framed as pragmatic cost-containment tools, the models would import foreign ... Borrowed Prices: Pharmaceuticals and the American Tab
The FTC, Express Scripts, and the High Cost of Lower Copays
Nearly 17 months after the Federal Trade Commission filed suit against the nation’s three largest pharmacy benefit managers (PBMs), the agency has reached a settlement with one of them: Express Scripts. The complaint alleged that PBMs harmed competition and patients by inflating insulin prices. PBMs negotiate drug prices with pharmaceutical manufacturers and pharmacies on behalf ... The FTC, Express Scripts, and the High Cost of Lower Copays
Fraud, PBMs, and the Cost of Looking the Other Way
Last month, the U.S. House Judiciary Committee released an interim staff report examining CVS Health’s relationships with digital pharmacy services. Led by Chairman Jim Jordan (R-Ohio), the report takes aim at a core policy concern: rising health-care costs. It frames competition and innovation as central tools for addressing those costs, a welcome emphasis in a ... Fraud, PBMs, and the Cost of Looking the Other Way
The Many Tradeoffs of Trump’s ‘Fat Shot’ Deal
Earlier this month, President Donald Trump announced deals with drugmakers to reduce prices and expand access to GLP-1 weight-loss drugs like Ozempic, Zepbound, and Wegovy. Originally developed to help diabetics manage their blood sugar, the drugs mimic the natural hormone glucagone-like-peptide-1 (GLP-1). GLP-1s trigger the pancreas to release insulin at times of high blood-sugar levels, ... The Many Tradeoffs of Trump’s ‘Fat Shot’ Deal
Antitrust at the Agencies: PBM Madness at the FTC, Part 2
As I noted in my last post, the Federal Trade Commission (FTC) announced Sept. 20 that it had filed a complaint: against the three largest prescription drug benefit managers (PBMs)—Caremark Rx, Express Scripts (ESI), and OptumRx—and their affiliated group purchasing organizations (GPOs) for engaging in anticompetitive and unfair rebating practices that have artificially inflated the ... Antitrust at the Agencies: PBM Madness at the FTC, Part 2
FTC Sues ‘Big 3’ Pharmaceutical Benefit Managers
My last post highlighted a July 2024 Federal Trade Commission (FTC) interim staff report that was critical of pharmaceutical benefit managers (PBMs)—so-called “middlemen” firms that specialize in negotiating with drugmakers for rebates on the list prices of drugs. I explained that the interim report’s analysis is at odds with economic research that delineates the substantial economic benefits ... FTC Sues ‘Big 3’ Pharmaceutical Benefit Managers
Antitrust at the Agencies: PBM Madness at the FTC, Part 1
“Curiouser and curiouser!” Cried Alice (she was so much surprised, that for the moment she quite forgot how to speak good English). — Lewis Carroll, Alice’s Adventures in Wonderland Let’s start more modestly, if less cleverly, with “curious.” The Federal Trade Commission (FTC) announced Sept. 20 that it had filed a complaint: against the three ... Antitrust at the Agencies: PBM Madness at the FTC, Part 1
The FTC Takes On Pharmaceutical Benefit Managers
The Federal Trade Commission (FTC) announced Sept. 20 that it was suing the three largest pharmaceutical benefit managers (PBMs)—Caremark Rx, Express Scripts (ESI), and Optum—alleging competition and consumer-protection law violations. This commentary provides information on controversies surrounding the economic effects of PBMs that led up to the suit. A follow-up commentary will assess the lawsuit ... The FTC Takes On Pharmaceutical Benefit Managers
The FTC Case Against PBM Rebates
About a month ago, the Wall Street Journal reported that the Federal Trade Commission (FTC) was preparing an antitrust suit against the nation’s three largest pharmaceutical benefit managers (PBMs), the intermediaries who negotiate drug prices on behalf of insurers and who manage benefits for nearly nine in 10 insured Americans. This development followed a two-year ... The FTC Case Against PBM Rebates
