America's Federal Trade Commission has been "raising antitrust concerns" about them for years, reports NBC News. The latest? America's three largest drug middlemen "inflated the costs of numerous life-saving medications by billions of dollars over the past few years, the FTC said in a report Tuesday." The top pharmacy benefit managers (PBMs) — CVS Health's Caremark Rx, Cigna's Express Scripts and UnitedHealth Group's OptumRx — generated roughly $7.3 billion through price hikes over about five years starting in 2017, the FTC said. The "excess" price hikes affected generic drugs used to treat heart disease, HIV and cancer, among other conditions, with some increases more than 1,000% of the national average costs of acquiring the medications, the commission said. The FTC also said these so-called Big Three health care companies — which it estimates administer 80% of all prescriptions in the U.S. — are inflating drug prices "at an alarming rate, which means there is an urgent need for policymakers to address it...." Some of the steepest drug markups were "hundreds and thousands of percent," according to Tuesday's report, which highlights just how profitable specialty drugs have become for the three leading PBMs. Cancer drugs alone made up nearly half of the $7.3 billion, the commission wrote, with multiple sclerosis medications accounting for another 25%. Dispensing highly marked-up specialty drugs was a massive income stream for the companies in 2021, the FTC found. Out of tens of thousands of drugs dispensed, the top 10 specialty generics alone made up nearly 11% of the companies' pharmacy-related operating income that year, the agency estimated. Across the 51 drugs the agency analyzed, the Big Three's price-markup revenue surged from $522 million in 2017 to $2.1 billion in 2021, the report said. "The FTC found that 22 percent of specialty drugs dispensed by PBM-affiliated pharmacies were marked up by more than 1,000 percent," reports The Hill, "while 41 percent were marked up between 100 and 1,000 percent. Among those drugs marked up by more than 1,000 percent, half of them were marked up by more than 2,000 percent." And the nonprofit site progressive news site Common Dreams shares some examples from the FTC's 60-page report: "For the pulmonary hypertension drug tadalafil (generic Adcirca), for example, pharmacies purchased the drug at an average of $27 in 2022, yet the Big Three PBMs marked up the drug by $2,079 and paid their affiliated pharmacies $2,106, on average, for a 30-day supply of the medication on commercial claims," the publication notes. That's a staggering average markup of 7,736%... The new analysis follows a July 2024 report that revealed Big Three PBM-affiliated pharmacies received 68% of the dispensing revenue generated by specialty drugs in 2023, a 14% increase from 2016... Responding to the FTC report, Emma Freer, senior policy analyst for healthcare at the American Economic Liberties Project — a corporate accountability and antitrust advocacy group — said in a statement Tuesday that "the FTC's second interim report lays bare the blatant profiteering by PBM giants, which are marking up lifesaving drugs like cancer, HIV, and multiple sclerosis treatments by thousands of percent and forcing patients to pay the price."

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