FTC Lets Big Insurers' PBMs Off Hook with Lenient Settlements

The Federal Trade Commission (FTC) has concluded its investigation into the business practices of the three largest pharmacy benefit managers (PBMs), CVS Caremark, Cigna's Express Scripts, and UnitedHealth's OptumRx. The FTC had accused these companies of engaging in anticompetitive behavior by steering patients toward higher-priced insulins that generated richer rebates for the PBMs.

The investigation found that drugmakers were forced to raise their list prices in order to get placed on the PBMs' formularies, resulting in inflated costs for patients. The FTC estimated that the settlements will save patients up to $8.5 billion over 10 years and another $4.5 billion through point-of-sale rebates.

However, critics argue that the settlements do not go far enough, as they do not require the PBMs to return any of the profits they made from their anticompetitive practices. Instead, the companies will simply agree to change their business practices for a defined number of years without facing any penalties or restitution.