About 40 percent of CVS Caremark clients saw negative specialty drug trends during the first three quarters of 2021, according to a report the pharmacy giant released Feb. 24.
Pharmacy benefit managers — the much-maligned middlemen between drug manufacturers and health insurers — often tilt the market, 80% of which is controlled by 3 of the largest PBMs, in their own and unusual ways.
The Federal Trade Commission under chair Lina Khan has yet to take a big swing at drug prices and the middlemen driving them up, but that may soon change with a vote coming next week.
Next Thursday, the FTC will vote on whether to issue orders to the largest of these middlemen, known as pharmacy benefit managers, “to study the competitive impact of contractual provisions, reimbursement adjustments, and other practices affecting drug prices, including those practices that may disadvantage independent or specialty pharmacies,” according to a new agenda.
Three companies dominate the pharmacy benefit manager market, accounting for 79 percent of all prescription claims in 2020, according to data from Health Industries Research Companies, an independent, non-partisan market research firm.
To assess market share, HIRC used self-reported data from 29 pharmacy benefit manager leaders collected in December 2020 and January 2021.
Shark Tank’s Mark Cuban made a splash last week in the world of drug pricing, pledging to cut out costly PBMs and deliver on a very simple plan with his new pharmacy, and some huge cost savings for consumers.
The current landscape heading into 2022 will keep pharmacy benefits under the microscope. Plan sponsors will evaluate their PBM’s pricing model to determine if their contract will deliver predictable costs, more opportunities for increased savings and improved care for their members.
For 2022, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and OptumRx (United Health Group)— increased the number of drugs they excluded from their standard formularies.
Each exclusion list contains 400 to 500 products. Growth in the number of excluded drugs slowed, due partly to the fact that so many drugs have already been dropped from PBMs’ formularies.
Between 2017 and 2019, pharmacy benefit managers' gross profit increased by 12 percent despite PBM retention of manufacturer rebates decreasing during this period, according to a report released Dec. 2 by the PBM Accountability Project.
Mark Cuban's new generic drug company is launching its own pharmacy benefit management company, The Wall Street Journal reported Oct. 25.
The company, called the Mark Cuban Cost Plus Drug Company, said the aim of the PBM is to be more transparent about drug costs and share more savings with customers, according to the Journal.