FTC Withdraws Prior Health Care Antitrust Policy Statements as It Continues to Investigate PBM Market

September 21, 2023
Hall Benefits Law, LLC

The Federal Trade Commission (FTC) recently unanimously voted to withdraw its previously issued policy statement that opposed state legislation increasing transparency over pharmacy benefit managers (PBMs). Consistent with heightened scrutiny of PBMs by federal agencies, the FTC issued a statement cautioning against reliance on prior advocacy statements regarding PBMs that no longer may be valid.

The FTC stated that although prior advocacy statements undoubtedly were well-intentioned based on potential risks that existed at the time, the market has changed substantially since that time. As a result, increased transparency concerning PBMs is now preferable and even necessary instead of being seen as a risk to market competitiveness.

In June 2022, the FTC launched an inquiry into the country’s six largest PBMs to determine whether they engage in anticompetitive practices and restrict patient access to affordable medications. The three largest PBMs – CVS Caremark, Cigna’s Express Scripts, and UnitedHealth Group’s OptumRx – control almost 80% of the PBM market. The next three largest PBMs are Humana, Prime Therapeutics, and MedImpact Healthcare Systems.

The Pharmaceutical Care Management Association, representing the interests of the PBM industry, opposed the FTC’s decision and statement. The Association claims that although the market may have changed over the years, the PBM industry has only become more competitive, with 73 full-service PBMs operating nationwide.

HBL has experience in all areas of benefits and employment law, offering a comprehensive solution to all your business benefits and HR/employment needs. We help ensure you are in compliance with the complex requirements of ERISA and the IRS code, as well as those laws that impact you and your employees. Together, we reduce your exposure to potential legal or financial penalties. Learn more by calling 470-571-1007.

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Hall Benefits Law, LLC

HBL offers employers comprehensive legal guidance on benefits in mergers and acquisitions, Employee Stock Ownership Plans (ESOPs), executive compensation, health and welfare benefits, healthcare reform, and retirement plans. We counsel a wide spectrum of clients including small, mid-sized, and large companies, 401(k) investment advisors, health insurance brokers, accountants, attorneys, and HR consultants, just to name a few. HBL is passionate about advising clients, and we are dedicated to our mission: to provide comprehensive, personalized, and practical ERISA and benefits legal solutions that exceed client expectations.

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