Pile-on over PBMs continues with FTC comments and a new bipartisan Senate bill – Endpoints News

More than 500 stake­hold­ers sent com­ments to the FTC on whether the com­mis­sion should look fur­ther in­to phar­ma mid­dle­men, known as PBMs, with many of the com­menters call­ing for more fed­er­al over­sight.

Sim­i­lar to the crit­i­cal open com­ment pe­ri­od in a dead­locked FTC ses­sion last Feb­ru­ary, phar­ma­cies and phar­ma­cy groups are con­tin­u­ing to call out the lack of trans­paren­cy among the top 3 PBMs, which con­trol about 80% of the mar­ket.

“What has be­come ap­par­ent dur­ing the in­crease of con­trol and au­thor­i­ty of PBMs in the pre­scrip­tion drug mar­ket, is that when PBM ac­tiv­i­ty neg­a­tive­ly im­pacts in­de­pen­dent phar­ma­cies, it al­so neg­a­tive­ly im­pacts con­sumers,” the Na­tion­al Com­mu­ni­ty Phar­ma­cists As­so­ci­a­tion said in its com­ment.

What’s dif­fer­ent be­tween Feb­ru­ary and now is that there is one more Biden-ap­point­ed com­mis­sion­er on the FTC, so the bal­ance has shift­ed to a 3-2 ad­van­tage for Lina Khan, open­ing the door for a clos­er look in­to PBMs.

A coali­tion of the largest em­ploy­ers in the US al­so sent a let­ter to Khan yes­ter­day out­lin­ing their “dis­tress with the con­tin­ued preda­to­ry be­hav­ior of the PBM in­dus­try, an in­ex­cus­able lack of over­sight, and the co­hort’s rec­om­men­da­tions for the Com­mis­sion to in­crease trans­paren­cy and ad­dress the un­ten­ably high costs in health care.”

And the Amer­i­can Col­lege of Rheuma­tol­ogy said it’s “par­tic­u­lar­ly con­cerned” with sev­er­al PBM prac­tices that neg­a­tive­ly im­pact pa­tients, in­clud­ing “PBM-im­posed ac­cess bar­ri­ers, such as step ther­a­py and pri­or au­tho­riza­tion, [that] de­lay and de­ny nec­es­sary care for pa­tients,” and the way PBMs “cre­ate ad­min­is­tra­tive bur­dens for clin­i­cians and take valu­able time away from pa­tient care.”

Con­gress is sim­i­lar­ly push­ing for such sun­shine, and it’s been a bi­par­ti­san ef­fort too.

Re­pub­li­can Sens. Chuck Grass­ley (IA) and Mike Braun (IN), along­side De­mo­c­rat Sen. Ron Wyden (OR), sub­mit­ted a let­ter to Khan last week, call­ing for some­thing to be done af­ter the com­mis­sion­ers re­mained dead­locked in that 2-2 vote in Feb­ru­ary on whether to for­mal­ly look in­to an­ti-com­pet­i­tive prac­tices of PBMs.

At the time, Khan said, “We have a re­al moral im­per­a­tive to act, this in­quiry is long over­due.”

Ear­li­er this week, chairs of their re­spec­tive com­mit­tees, Sens. Maria Cantwell (D-WA) and Grass­ley in­tro­duced a new bill to shine a light on the PBM mar­ket and em­pow­er the FTC and state at­tor­neys gen­er­al to stop un­fair and de­cep­tive PBM busi­ness prac­tices.

The leg­is­la­tion would make it il­le­gal for PBMs to en­gage in what’s known as “spread pric­ing” in which they charge health plans and pay­ers more for a pre­scrip­tion drug than what they re­im­burse to the phar­ma­cy, and they pock­et the dif­fer­ence. The bill would al­so pro­hib­it PBMs from claw­ing back pay­ments made to phar­ma­cies, in­creas­ing fees or low­er­ing re­im­burse­ments to off­set re­im­burse­ment changes in fed­er­al­ly-fund­ed health plans.

Mean­while, in­dus­try group PhRMA praised a new re­port from Xcen­da that found PBMs are in­creas­ing­ly re­strict­ing pa­tient ac­cess to pre­scrip­tion med­i­cines.

In 2022, the re­port notes, 1,156 med­i­cines were ex­clud­ed from at least one of the three largest PBMs’ stan­dard com­mer­cial in­sur­ance for­mu­la­ries, which is a near­ly 1,000% in­crease in the num­ber of ex­clud­ed med­i­cines since 2014.

What’s worse is that brand-name drugs with­out a gener­ic or biosim­i­lar al­ter­na­tive ac­count­ed for near­ly half (47%) of to­tal for­mu­la­ry ex­clu­sions, leav­ing pa­tients with few­er and typ­i­cal­ly more ex­pen­sive treat­ment op­tions.

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