This week, the Federal Trade Commission released a report revealing the impact drug middlemen are having on the cost of prescription medications in the United States.
According to the report, six of the largest pharmacy benefit managers control 95% of the prescriptions filled in the U.S. These third-party companies negotiate prices between insurance companies and pharmacies, often leading to higher out-of-pocket costs for patients.
“One in three people in this country cannot afford to pay for their prescription drugs,” said Merith Basey, executive director of the advocacy group Patients for Affordable Drugs. “These negotiations are one big black box. We don’t know what goes on behind those closed doors. Show us the receipts if you say you’ve been set up to support patients and to negotiate a better deal.”
The FTC report states pharmacy benefit managers (PBMs) “wield enormous power over patients’ ability to access and afford their prescription drugs, allowing PBMs to significantly influence what drugs are available and at what price.”
The report goes on to highlight the dire consequences for patients, with nearly 30% of Americans surveyed reporting rationing or skipping doses of prescribed medicines due to high costs.
“My medications are around $4,000-$5,000 without any insurance applied [per month],” said Giovanna Burno, a 26-year-old with transverse myelitis. Her condition forces her to take 24 prescription medications each month.
“I get to know my pharmacist really well because I get to see them every month,” added Kevin Trager, a 35-year-old managing Type 1 Diabetes for 23 years.
According to the FTC report, the market for pharmacy benefit management services has become highly concentrated, with the top three PBMs processing nearly 80% of prescriptions dispensed by U.S. pharmacies in 2023.
Scripps News reached out to the Pharmaceutical Care Management Association for comment on the FTC’s report.
According to Congress, Americans pay more for their medications than any other country in the world.
Kris Garcia, who has four blood conditions, highlighted the high costs of his medication due to the control of PBMs on pricing.
According to the FTC’s report, some of the PBMs have not been forthcoming in providing required information, hindering the Commission’s ability to perform its statutory mission.
