Oncology News Central (ONC)What the Scathing FTC Report on PBMs Means for Oncology

FTC Report Exposes PBM Practices’ Impact on Drug Pricing and Patient Care in Oncology

The Federal Trade Commission (FTC) has released an interim report highlighting how pharmacy benefit managers (PBMs) influence drug costs and patient care, particularly in oncology. The report, based on incomplete data from the top six PBMs, suggests these middlemen inflate drug prices and restrict patient access to medications. This development may catalyze legislative action and further investigations into PBM practices.

Key Points:

• The FTC report criticizes PBMs for inflating drug costs and squeezing pharmacies
• Three PBMs control 80% of the prescription drug market; six control 94%
• PBMs often force mandatory mail-order prescriptions through their own pharmacies
• Some PBMs have established offshore group purchasing organizations (GPOs)
• Vertical integration allows PBMs to dictate treatment decisions and drug accessibility
• PBMs influence biosimilar market access through rebate negotiations
• The report may fuel Congressional action on PBM reform
• FTC is rumored to be considering legal action against PBMs
• PBM practices can lead to treatment delays, denials, and medication waste
• Forced mail-order can disrupt integrated cancer care delivery
• PBMs’ influence extends to both oral and infusible cancer drugs
• Some PBMs are creating their own branded biosimilars
• 340B contract pharmacies allow PBMs to “double down” on discounts

“They’re [PBMs] fueling drug prices, and that costs every payer, whether it is a Medicare or a commercial payer. They are creating pharmacy deserts across the country in terms of rural areas. They have gotten to a point where any of the good that they have contributed is basically just swamped by the bad.”
– Ted Okon, MBA, Community Oncology Alliance (COA) Executive Director

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