{"id":13660,"date":"2024-11-23T13:37:35","date_gmt":"2024-11-23T13:37:35","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=13660"},"modified":"2024-11-23T13:39:48","modified_gmt":"2024-11-23T13:39:48","slug":"pbm-reforms-drive-positive-medication","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/pbm-reforms-drive-positive-medication\/","title":{"rendered":"PBM Reforms Drive Positive Impact on Medication Costs"},"content":{"rendered":"\r\n<div id=\"rank-math-toc\" class=\"wp-block-rank-math-toc-block has-pale-ocean-gradient-background has-background\"><nav>\r\n<ul>\r\n<li><a href=\"#introduction\">Introduction<\/a><\/li>\r\n<li><a href=\"#background-on-the-ft-cs-actions-against-pb-ms\">Background on the FTC\u2019s Actions Against PBMs<\/a><\/li>\r\n<li><a href=\"#pb-ms-claims-against-the-ftc\">PBMs\u2019 Claims Against the FTC<\/a><\/li>\r\n<li><a href=\"#ft-cs-response-and-counterarguments\">FTC\u2019s Response and Counterarguments<\/a><\/li>\r\n<li><a href=\"#implications-for-the-healthcare-and-pharmacy-industry\">Implications for the Healthcare and Pharmacy Industry<\/a><\/li>\r\n<li><a href=\"#conclusion\">Conclusion<\/a><\/li>\r\n<li><a href=\"#fa-qs\">FAQs\u00a0<\/a>\r\n<ul>\r\n<li><a href=\"#1-what-are-pb-ms\">1. What are PBMs?<\/a><\/li>\r\n<li><a href=\"#2-why-is-the-ftc-suing-pb-ms\">2. Why is the FTC suing PBMs?<\/a><\/li>\r\n<li><a href=\"#3-what-constitutional-arguments-are-pb-ms-making\">3. What constitutional arguments are PBMs making?<\/a><\/li>\r\n<li><a href=\"#4-how-does-this-case-affect-consumers\">4. How does this case affect consumers?<\/a><\/li>\r\n<li><a href=\"#5-when-will-the-case-be-decided\">5. When will the case be decided?<\/a><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/nav><\/div>\r\n\r\n\r\n\r\n<h2 id=\"introduction\" class=\"wp-block-heading\"><strong>Introduction<\/strong><\/h2>\r\n\r\n\r\n\r\n<p><a href=\"https:\/\/www.ftc.gov\/terms\/pharmacy-benefits-managers-pbm\" target=\"_blank\" rel=\"noopener\">Pharmacy benefit managers (PBMs)<\/a> have launched a legal counteroffensive against the Federal Trade Commission (FTC), challenging its authority to oversee and regulate their industry. Express Scripts, Caremark, and Optum Rx\u2014three of the nation\u2019s largest Pharmacy Benefit Managers owned by Cigna, CVS Health, and UnitedHealth Group, respectively\u2014are at the forefront of this lawsuit, arguing that the FTC\u2019s actions undermine the U.S. Constitution and democratic principles.<\/p>\r\n\r\n\r\n\r\n<p>The lawsuit follows the FTC\u2019s September 2023 allegations that Pharmacy benefit managers acted as intermediaries to inflate insulin prices, harming consumers. While the FTC claims its actions aim to protect patients from high drug costs, PBMs assert that the agency\u2019s administrative processes are unconstitutional and overstep its regulatory bounds.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"background-on-the-ft-cs-actions-against-pb-ms\" class=\"wp-block-heading\"><strong>Background on the FTC\u2019s Actions Against PBMs<\/strong><\/h2>\r\n\r\n\r\n\r\n<p><strong>Allegations Against PBMs<\/strong><\/p>\r\n\r\n\r\n\r\n<p>The FTC accuses Pharmacy Benefit Managers of engaging in pricing practices that inflate the cost of life-saving drugs like insulin. According to the FTC, Pharmacy Benefit Managers\u00a0leverage their position as middlemen between drug manufacturers, insurers, and pharmacies to manipulate pricing and increase profits.<\/p>\r\n\r\n\r\n\r\n<p><strong>The Role of Pharmacy Benefit Managers<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Pharmacy Benefit Managers play a key role in negotiating drug prices, establishing formularies, and determining which medications are covered by insurance plans. They argue that their practices lower net drug costs for consumers by negotiating discounts and rebates with manufacturers.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"pb-ms-claims-against-the-ftc\" class=\"wp-block-heading\"><strong>PBMs\u2019 Claims Against the FTC<\/strong><\/h2>\r\n\r\n\r\n\r\n<p><strong>Constitutional Challenges<\/strong><\/p>\r\n\r\n\r\n\r\n<p>It claim the FTC\u2019s administrative law process violates constitutional principles by bypassing traditional judicial review. They argue that:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>Administrative law judges overseeing the process are insulated from democratic oversight.<\/li>\r\n\r\n\r\n\r\n<li>The FTC unfairly serves as both prosecutor and judge in its own cases.<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<p>\u201cThis sweeping attempt to reshape an entire industry via law enforcement would never pass muster in a U.S. District Court,\u201d the PBMs stated in their lawsuit.<\/p>\r\n\r\n\r\n\r\n<p><strong>Interference with Private Contracts<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Its also contend that the FTC\u2019s actions interfere with private contracts and transactions, forcing them to renegotiate agreements based on subjective viewpoints. They argue that such overreach disrupts the competitive dynamics of the pharmacy benefits industry.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"ft-cs-response-and-counterarguments\" class=\"wp-block-heading\"><strong>FTC\u2019s Response and Counterarguments<\/strong><\/h2>\r\n\r\n\r\n\r\n<p><strong>Defense of Oversight Authority<\/strong><\/p>\r\n\r\n\r\n\r\n<p>The FTC defends its role as a regulatory body tasked with ensuring fair practices in industries like healthcare. FTC spokesperson Douglas Farrar countered the its claims, stating:<\/p>\r\n\r\n\r\n\r\n<p>\u201cIt has become fashionable for corporate giants to argue the FTC is unconstitutional to distract from business practices that we allege harm sick patients by forcing them to pay huge sums for life-saving medicine. It will not work.\u201d<\/p>\r\n\r\n\r\n\r\n<p><strong>The Constitutional Debate<\/strong><\/p>\r\n\r\n\r\n\r\n<p>Critics of the <a href=\"https:\/\/www.siia.net\/a-second-trump-administration-should-rein-in-ftc-overreach\/\" target=\"_blank\" rel=\"noopener\">FTC<\/a>, including officials in the Trump administration, argue that federal agencies wield excessive power, creating an imbalance between the executive branch, Congress, and regulatory bodies. The Supreme Court\u2019s recent decisions to limit agency authority further complicate the FTC\u2019s ability to enforce regulations.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"implications-for-the-healthcare-and-pharmacy-industry\" class=\"wp-block-heading\"><strong>Implications for the Healthcare and Pharmacy Industry<\/strong><\/h2>\r\n\r\n\r\n\r\n<p><strong>Impact on Drug Pricing Practices<\/strong><\/p>\r\n\r\n\r\n\r\n<p>If the Pharmacy Benefit Managers succeed in their lawsuit, it could limit the FTC\u2019s ability to regulate pharmacy benefits, potentially affecting drug pricing strategies and patient access to affordable medications. The outcome may also set a precedent for how federal agencies interact with private industries.<\/p>\r\n\r\n\r\n\r\n<p><strong>Regulatory Power in Question<\/strong><\/p>\r\n\r\n\r\n\r\n<p>This case underscores broader debates about the scope of federal agencies\u2019 authority. A ruling in favor of the PBMs could weaken the regulatory reach of agencies like the FTC, reshaping oversight in sectors beyond healthcare.<\/p>\r\n\r\n\r\n\r\n<h2 id=\"conclusion\" class=\"wp-block-heading\"><strong>Conclusion<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>The lawsuit filed by PBMs against the FTC raises fundamental questions about the role and authority of regulatory agencies in the U.S. healthcare system. While the FTC seeks to curb practices it deems harmful to consumers, PBMs argue that the agency\u2019s actions overreach constitutional limits and disrupt the industry.<\/p>\r\n\r\n\r\n\r\n<p>The outcome of this legal battle could have far-reaching implications for drug pricing, healthcare affordability, and the balance of power between federal agencies and private entities. As the case unfolds, stakeholders across the healthcare sector will closely watch how these debates shape the future of pharmacy benefits management and regulatory governance.<\/p>\r\n\r\n\r\n\r\n<p><span data-teams=\"true\">Discover the latest <a id=\"menur1hf\" class=\"fui-Link ___1q1shib f2hkw1w f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1s184ao f1mk8lai fnbmjn9 f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh fhgqx19 f1olyrje f1p93eir f1nev41a f1h8hb77 f1lqvz6u f10aw75t fsle3fq f17ae5zn\" title=\"https:\/\/distilinfo.com\/healthplan\/\" href=\"https:\/\/distilinfo.com\/healthplan\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link payers&#039; news updates\"><strong>payers&#8217; news updates<\/strong><\/a> with a single click. Follow <a id=\"menur1hh\" class=\"fui-Link ___1q1shib f2hkw1w f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1s184ao f1mk8lai fnbmjn9 f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh fhgqx19 f1olyrje f1p93eir f1nev41a f1h8hb77 f1lqvz6u f10aw75t fsle3fq f17ae5zn\" title=\"https:\/\/distilinfo.com\/healthplan\/\" href=\"https:\/\/distilinfo.com\/healthplan\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link DistilINFO HealthPlan\">DistilINFO HealthPlan<\/a> and stay ahead with updates on <strong>medical advancements<\/strong>. Join our community today!<\/span><\/p>\r\n\r\n\r\n\r\n<h2 id=\"fa-qs\" class=\"wp-block-heading\"><strong>FAQs\u00a0<\/strong><\/h2>\r\n\r\n\r\n\r\n<h3 id=\"1-what-are-pb-ms\" class=\"wp-block-heading\"><strong>1. What are PBMs?<\/strong><\/h3>\r\n\r\n\r\n\r\n<p>Ans: Pharmacy Benefit Managers are intermediaries that negotiate drug prices between manufacturers, insurers, and pharmacies, aiming to manage prescription drug costs.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"2-why-is-the-ftc-suing-pb-ms\" class=\"wp-block-heading\"><strong>2. Why is the FTC suing PBMs?<\/strong><\/h3>\r\n\r\n\r\n\r\n<p>Ans: The FTC alleges that PBMs engage in practices that inflate drug prices, particularly insulin, harming consumers and increasing healthcare costs.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"3-what-constitutional-arguments-are-pb-ms-making\" class=\"wp-block-heading\"><strong>3. What constitutional arguments are PBMs making?<\/strong><\/h3>\r\n\r\n\r\n\r\n<p>Ans: PBMs argue that the FTC\u2019s administrative process violates constitutional principles by bypassing traditional court oversight and interfering with private contracts.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"4-how-does-this-case-affect-consumers\" class=\"wp-block-heading\"><strong>4. How does this case affect consumers?<\/strong><\/h3>\r\n\r\n\r\n\r\n<p>Ans: The outcome could influence drug pricing and availability. If PBMs win, it may limit regulatory oversight, potentially affecting affordability and transparency in the pharmacy benefits industry.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"5-when-will-the-case-be-decided\" class=\"wp-block-heading\"><strong>5. When will the case be decided?<\/strong><\/h3>\r\n\r\n\r\n\r\n<p>Ans: The FTC\u2019s complaint is scheduled for a hearing on August 27, 2025, barring any significant delays or legal developments.<\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>Introduction Pharmacy benefit managers (PBMs) have launched a legal counteroffensive against the Federal Trade Commission (FTC), challenging its authority to&#8230; <a href=\"https:\/\/distilinfo.com\/healthplan\/pbm-reforms-drive-positive-medication\/\" style=\"white-space: nowrap;\">Continue Reading <i class=\"fas fa-long-arrow-alt-right\" style=\"vertical-align: middle;\"><\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":13661,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[264],"class_list":{"0":"post-13660","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-distilinfo-originals","8":"tag-pbm","9":"entry"},"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/13660"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=13660"}],"version-history":[{"count":4,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/13660\/revisions"}],"predecessor-version":[{"id":13711,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/13660\/revisions\/13711"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/13661"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=13660"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=13660"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=13660"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}