This week, the Federal Trade Commission released a report revealing the impact drug middlemen have on the cost of prescription medications in the United States.
As per the report, six major pharmacy benefit managers control 95% of the prescriptions filled in the U.S., acting as intermediaries between insurance companies and pharmacies. This often results in higher out-of-pocket expenses for patients.
“One in three individuals in the country struggle to afford their prescription drugs,” stated Merith Basey, executive director of Patients for Affordable Drugs. She emphasized the lack of transparency in the negotiation process and urged for more accountability.
The FTC report highlights that pharmacy benefit managers hold significant influence over patients’ access to affordable medications, leading to situations where patients ration or skip doses due to high costs.
Giovanna Burno, a 26-year-old with transverse myelitis, shared her experience of the high cost of medications, with monthly expenses ranging from $4,000-$5,000. She relies on 24 different prescription medications monthly due to her condition.
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Kevin Trager, a 35-year-old managing Type 1 Diabetes, mentioned the impact of PBMs on insulin prescriptions. Following an insurance-mandated switch of insulin brands, Trager faced dosing challenges, leading to potential overdosing.
The FTC report underscores the concentration of pharmacy benefit management services in a few major players, with significant control over prescription drug access and pricing.
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The Pharmaceutical Care Management Association, representing PBMs, was contacted for input on the FTC report but has not responded yet.
Congress highlights the increased medication costs in the U.S. compared to other countries, pointing to the role of middlemen in pricing structures.
Kris Garcia, dealing with multiple blood conditions, elucidated the high cost of emergency medications, emphasizing the financial strain even with insurance coverage.
According to the FTC report, some PBMs have been resistant to sharing necessary information, hindering the Commission’s regulatory efforts. This could lead to legal actions to enforce compliance.
