34 HARTFORDBUSINESS.COM | MARCH 20, 2023
The FTC's June inquiry was
launched following its February 2022
request for information about PBMs
and the 24,000 public comments
it received as of June. The inquiry
is looking into PBM practices
that have been raised in recent
years, including:
• Methods to steer patients toward
PBM-owned pharmacies.
• Fees charged to
unaffiliated pharmacies.
• Complex methods to determine
pharmacy reimbursement.
• The impact of rebates and fees from
drug manufacturers on formulary
design and the costs of prescription
drugs to payers and patients.
• The use of specialty drug lists and
specialty drug policies.
• The prevalence of prior
authorizations and other
administrative restrictions.
• Potentially unfair audits of
independent pharmacies.
This lack of transparency — and
questionable pricing schemes — in
the world of PBMs is increasing the
cost of generic medications rather
than saving money for patients,
governments and employers,
according to research by the
University of Southern California's
Schaeffer Center for Health Policy
and Economics.
In some cases, patients and
doctors have been denied access to
less expensive generic medications
and forced into higher-cost treat-
ments that make a bigger profit for
the PBM.
According to the USC research,
these tactics have led to billions in
overpayment. When patients — a
business owner's staff — pay more
than $100 for a medication they
are more likely to abandon or delay
needed treatment.
Connecticut has been a leader in
passing policies that address some
of the most blatant PBM issues.
But there's more work to do — the
industry needs to be held accountable
because just as states and the federal
government find ways to combat
these practices, a new one pops up.
As the FTC effort unfolds,
employers should support changes
that prioritize transparency from the
PBMs and demand that they use
their negotiated savings to lower
costs for beneficiaries.
Doing so could have an impact on
a company's bottom line both now
and in the future.
Tony Sheridan is president and
CEO of the Chamber of Commerce
of Eastern Connecticut.
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