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FTC Reverses Previous Deadlock in Pivotal Vote to Probe Pharmacy Benefit Managers’ Practices

On June 7, 2022, in a unanimous 5-0 vote, The US Federal Trade Commission reversed a previous 2-2 deadlock vote that will result in the commissions probe of pharmacy benefit managers including the top six PBMs; CVS Caremark, Express Scripts, Inc. OptumRx, Inc., Humana Inc., Prime Therapeutics LLC and MedImpact Healthcare Systems, Inc. After the FTC failed to approve a similar study in February, the commission was flooded with comments from pharmacies and other industry stakeholders. Members of the commission that opposed the previous probe efforts have indicated that the new inquiry included their requests to review how PBM industry practices have contributed to rising drug costs. Additionally, pharmacies are relieved the FTC probe will look at, reimbursement, fees to pharmacies, clawbacks and unfair audit practices, and how PBMs steer patients to affiliated pharmacies. FTC Chair Lina Khan commented, “Although many people have never heard of pharmacy benefit managers, these powerful middlemen have enormous influence over the U.S. prescription drug system.”

The PBMs have 90 days to respond to the FTC’s Order. The FTC can subsequently publish certain information in a report or report information to congressional representatives. In the meantime, while the FTC collects the details that those in the industry have long known regarding abusive PBM practices, Boesen Snow can assist clients in every stage of PBM engagement including:

-PBM audit gap analysis
-PBM network enrollment and termination
-PBM audit submission, responses, and appeals
-Arbitration and litigation
-Lobbying and legislative efforts

Boesen Snow’s team includes pharmacist/attorneys with decades of pharmacy operations experience, a previous PBM auditor, litigators, and lobbyists.

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