Feds open another PBM probe

CMS is auditing vertically integrated Medicare Part D sponsors, including pharmacy benefit managers and payers, according to HHS' Office of Inspector General.

The agency said the probe is in response to "a wave of vertical integration between PBMs, health insurers, and pharmacies" over recent years. A common concern for vertically integrated models is inflated drug prices, the OIG said, so CMS is investigating a few unspecified insurers and PBMs on their prices for Part D medications. 

On April 18, the Federal Trade Commission, Justice Department and HHS unveiled an online portal for the public to report anticompetitive healthcare practices.

Multiple federal investigations into PBMs are already underway. The FTC launched its probe in summer 2022, and in spring 2023, the House Committee on Oversight and Accountability opened one targeting allegations of anticompetitive practices. 

The FTC is scrutinizing the six largest PBMs: CVS Caremark, Express Scripts, OptumRx, Humana Pharmacy Solutions, Prime Therapeutics and MedImpact Healthcare Systems. In 2023, these companies accounted for 94% of all prescription claims. 

Among those six PBMs, none have fully complied, FTC Chair Lina Khan said in a Feb. 13 letter.

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