FTC drug-price settlements fall short as PBMs exploit new private-label loopholes
The FTC’s recent agreements with Express Scripts, CVS Caremark and soon OptumRx aim to curb drug costs, but analysts say they leave major loopholes untouched.
The Federal Trade Commission finalized settlements with Express Scripts, CVS Caremark and is negotiating with OptumRx, promising to lower out-of-pocket prescription expenses and increase pricing transparency. The agreements target two PBM tactics: rebate-driven formularies and spread pricing, mandating that patient costs reflect net prices rather than inflated list prices. However, the provisions largely cover only standard insurance offerings, allowing PBMs to steer employers toward non-standard plans that lack consumer protections.
Analysts also highlight that the settlements overlook PBMs’ new strategy of creating private-label biosimilars, which they prioritize on formularies while excluding independent manufacturers. Examples include Express Scripts’ Quallent Pharmaceuticals and CVS Caremark’s Cordavis-produced Hyrimoz replacing Humira. The article argues that without banning such self-preferencing, genuine cost relief for patients remains unlikely.
Why it matters
Consumers may not see lower drug prices because key PBM practices remain unaddressed.
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