Seeing Is Believing

Misinformation, disinformation, and fear tactics kill progress!

The Federal Trade Commission & States Have Uncovered Fraud

The Federal Trade Commission, as well as audits in numerous States, have revealed how PBMs increase drug prices, decrease transparency, and hinder access to care.

Federal Trade Commision

The Federal Trade Commission filed a lawsuit against the three largest PBMs (CVSCaremark, Express Scripts, and OptumRx) for engaging in practices that hinder competition and offering unfair rebates which directly inflated the list price of insulin drugs. The FTC claims that these PBMs pushed pharmaceutical manufacturers to compete for favorable formulary placement by raising prices, which in turn increased rebates paid to the PBMs. The FTC further found that the "Big 3 PBMs" marked up numerous lifesaving drugs, including medications to treat heart disease and cancer. These PBMs generated over 7.3 billion of dispensing revenue in excess of NADAC and an estimated 1.4 billion of income from spread pricing.

MS Board of Pharmacy

The Mississippi Board of Pharmacy performed an audit of Optum, where they state Optum paid affiliated pharmacies 833% compared to independent pharmacies 100% for the same drug (Azithromycin) on the same date of service.

On a separate date for omeprazole, the MSBOP states that Optum paid affiliated pharmacies 2250%, compared to 100% for non-affiliated independent pharmacies.

Furthermore, it was found that patients paid the total claim cost 81.9% of the time at independent pharmacies versus only 63.4% of the time at chain pharmacies and 46.1% of the time at affiliated pharmacies.

Why This Matters

Freedom of Choice: PBMs are forcing patients to use mail-order services or distant pharmacies, limiting their options.
Fairness: Unfair practices by PBMs are forcing pharmacies to lose money, turn patients away or close altogether.
Access to Care: Over 300 independent pharmacies closed nationwide last year, creating “pharmacy deserts” in many Mississippi communities.