Lawmakers ask FTC to review pharmacy benefit manager mergers
Republican Congressmen are asking a federal agency to study whether past mergers by pharmacy benefit managers have been good for consumers.
The request comes on the brink of two pending major takeovers in the industry. The Justice Department is currently reviewing two proposed deals involving PBMs—CVS’s acquisition of Aetna and Cigna’s purchase of Express Scripts. The lawmakers didn’t mention those deals in their letter.
“Because some mergers may benefit patients while other mergers may harm patients, we believe it is important to closely monitor these trends,” wrote Representatives Greg Walden, Gregg Harper and Michael Burgess on Friday. Walden is the chairman of the House Committee on Energy and Commerce, which has legislative jurisdiction over many healthcare matters.
PBMs typically contract with health plans or employers to provide prescription benefits to workers, and they negotiate with pharmaceutical companies about what treatments are covered and what types of co-pays patients assume.
The business practices of these middlemen have recently attracted scrutiny from the Trump administration, which is considering new regulations as a way of dealing with drug costs.
Three major PBMs—CVS, Express Scripts and UnitedHealth Group’s OptumRx unit—oversee about 70 percent of prescriptions dispensed each year in the U.S., the lawmakers said in their letter. There is conflicting information about whether a series of deals that helped consolidate that market have benefited consumers, or if the combinations instead have served to boost profits at the merging companies, the Republicans said.
In comments on the lawmakers’ request, Express Scripts said it helps save clients money, and that it is “proud of the work we do for more than 3,000 payers to help make medicines more affordable and accessible for 83 million people.”
Representatives for CVS and UnitedHealth didn’t immediately return requests for comment.