Lina Khan (Saul Loeb/Pool via AP)

FTC wants to know: How are PBMs af­fect­ing drug af­ford­abil­i­ty and ac­cess?

Fol­low­ing the Fed­er­al Trade Com­mis­sion’s de­ci­sion to not, at least ini­tial­ly, dig deep­er in­to phar­ma mid­dle­men known as PBMs, the com­mis­sion is now seek­ing com­ments on ways that these mas­sive, ver­ti­cal­ly in­te­grat­ed PBMs are af­fect­ing drug af­ford­abil­i­ty and ac­cess.

PBMs — led by the big 3 of Unit­ed­Health’s Op­tum­Rx, CVS Care­mark, and Cigna’s Ex­press Scripts con­trol­ling al­most 80% of the mar­ket — gen­er­al­ly make their mon­ey by man­ag­ing pre­scrip­tion drug ben­e­fits on be­half of pri­vate health in­sur­ers, Medicare Part D drug plans, large em­ploy­ers, and oth­er pay­ers. But the PBMs al­so fig­ure out ways to tilt the mar­ket in their fa­vor, as the FTC not­ed how the largest PBMs are ver­ti­cal­ly in­te­grat­ed with health in­sur­ance com­pa­nies and spe­cial­ty phar­ma­cies, “giv­ing them fi­nan­cial in­cen­tives to steer pa­tients to use their af­fil­i­at­ed ser­vices.”

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