Pharmacy benefit managers CVS Caremark, OptumRx and Express Scripts inflated costs for specialty generic drugs to treat diseases such as cancer and HIV to the tune of $7.3 billion over six years, according to a report the Federal Trade Commission unveiled Tuesday.
The CVS Health subsidiary, UnitedHealth Group division and Cigna subsidiary employed tactics such as marking up prices, favoring more expensive medicines, paying affiliated pharmacies higher fees than other pharmacies and charging clients more than the PBMs paid for medications, the FTC found during an investigation that began in 2022.
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“The three major pharmacy benefit managers hiked costs for a wide range of lifesaving drugs, including medications to treat heart disease and cancer,” FTC Chair Lina Khan said in a news release.
The commission unanimously voted to release the 57-page interim report that builds on another interim report it published in July.
The FTC analyzed data for 51 specialty generic drugs dispensed from 2017-2022 for patients with commercial insurance or Medicare Part D plans managed by CVS Caremark, Express Scripts and OptumRx.
The investigation revealed the three biggest PBMs undertook a variety of actions that boosted their earnings but increased costs for plan sponsors, taxpayers and patients, according to the FTC.
For instance, CVS Caremark, Express Scripts and OptumRx reimbursed affiliated pharmacies $3,930 on average for a 30-day supply of dimethyl fumarate to treat multiple sclerosis, or more than 22 times its $177 price. The PBMs also generated $1.4 billion from “spread pricing” by charging employers, insurers or the government more than they paid for drugs.