Forbes January 2, 2025
PBMs, the pharmaceutical industry middlemen that negotiate drug prices and determine formularies for commercial payers and insurers, have been the subject of growing criticism for years. A measure of this criticism has been the action of the FTC which issued a scathing report in July 2024. This was followed two months later by a formal lawsuit against the three largest PBMs, Caremark Rx, Express Scripts and Optum Rx. The report laid out lack of transparency and numerous forms of self-dealing that included steering patients to affiliated pharmacies, limiting access to biosimilar medications in favor of more expensive branded alternatives and profiting from negotiating handsome rebates with manufacturers, in return for preferential tier placement of specific drugs. The lawsuit focused on...
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