US drug ‘gatekeepers’ face FTC antitrust lawsuit over insulin prices

PBMs accused of blocking competition, inflating costs

The Federal Trade Commission (FTC) has filed an antitrust lawsuit against three of the largest pharmacy benefit managers (PBMs) in the United States, accusing them of blocking competition and inflating the prices of insulin. The lawsuit, filed in federal court in the District of Columbia, alleges that the PBMs have used their market power to harm competition and consumers by:

• Restricting access to cheaper insulin
• Raising the prices of insulin
• Blocking the development of new insulin products

The FTC alleges that the PBMs' conduct has resulted in higher insulin prices for consumers and has made it more difficult for people with diabetes to get the medication they need. The lawsuit seeks to stop the PBMs' anticompetitive conduct and to restore competition to the insulin market.

PBMs are the middlemen between drug manufacturers and insurers

PBMs are responsible for negotiating drug prices with manufacturers and then passing those prices on to insurers. They also manage prescription drug benefits for their clients, which include health plans, employers, and government programs. The three PBMs named in the FTC's lawsuit are CVS Caremark, Express Scripts, and OptumRx. These three companies control over 80% of the PBM market in the United States.

PBMs have been accused of anticompetitive behavior for years

The FTC's lawsuit is the latest in a series of antitrust actions against PBMs. In 2019, the FTC reached a settlement with OptumRx over allegations that the company had engaged in anticompetitive conduct. The settlement required OptumRx to change its business practices and to pay $100 million in penalties.

The FTC's lawsuit against CVS Caremark, Express Scripts, and OptumRx is a significant step in the agency's efforts to address anticompetitive conduct in the pharmaceutical industry. The lawsuit is likely to have a major impact on the PBM industry and could lead to lower insulin prices for consumers.

What can you do if you're concerned about the cost of insulin?

If you're concerned about the cost of insulin, there are a few things you can do:

• Talk to your doctor about your options. There may be different types of insulin or other medications that are cheaper or more affordable for you.
• Shop around for the best price. You can compare prices at different pharmacies or use a prescription discount card.
• Contact your insurance company. Your insurance company may be able to help you find a more affordable insulin plan.
• Look into patient assistance programs. There are a number of patient assistance programs that can help you get free or discounted insulin.