Good morning, healthcare professional.
The FTC released its interim report on PBM practices, confirming what pharmacy owners have argued for years: concentrated market power has driven closures, reduced patient access, and inflated drug costs. State attorneys general launched investigations while the bipartisan congressional pharmacy caucus introduced reform measures. Advocacy organizations are mobilizing the largest coordinated grassroots campaign in recent industry history.
In today's healthcare digest:
- FTC interim report confirms anticompetitive PBM practices
- State attorneys general launch coordinated PBM investigations
- National pharmacy coalition announces unified reform platform
- New analysis quantifies PBM impact on pharmacy closures
FTC Interim Report: PBM Market Concentration Harms Pharmacies and Patients
Bottom Line: Three companies controlling 80% of the market enabled spread pricing, patient steering, and retroactive DIR fees. Share this report with your congressional representatives and state legislators.
The FTC's findings provide the strongest regulatory evidence that PBM market concentration harms pharmacies and patients. Key findings include spread pricing generating billions in undisclosed profits, steering patients toward PBM-owned pharmacies through formulary manipulation, and retroactive DIR fees creating unpredictable financial exposure. This report is a critical advocacy tool for pharmacy owners.
State Attorneys General Launch Coordinated PBM Investigations
Bottom Line: Ohio, Kansas, Arkansas, and Mississippi are investigating Medicaid spread pricing and network adequacy. Document your PBM interactions to support these investigations.
Attorneys general announced coordinated investigations focusing on Medicaid managed care spread pricing and network adequacy. These state-level enforcement actions complement federal legislative efforts and can result in binding consent decrees that change PBM behavior regardless of federal legislation. Pharmacies in these states may be contacted for data and testimony.
National Pharmacy Coalition Announces Unified Reform Platform
Bottom Line: NCPA, APhA, and NASPA released a unified platform demanding fiduciary duty, spread pricing prohibition, and network adequacy standards. Engage with your associations to support this effort.
The coalition's platform calls for PBM fiduciary duty to plan sponsors, prohibition of spread pricing, mandatory rebate pass-through, and pharmacy network adequacy standards. This consolidates previously fragmented advocacy efforts into a single, coherent set of demands that legislators can act on.
New Analysis: PBM Practices Linked to 25% of Pharmacy Closures
Bottom Line: USC Schaeffer Center research found PBM reimbursement practices contributed to 25% of independent pharmacy closures over five years. This data strengthens the case for regulatory intervention.
The research found that below-cost reimbursement rates and retroactive DIR fee clawbacks were contributing factors in approximately 25% of closures. This quantitative evidence connects PBM behavior to the pharmacy access crisis. The data point is powerful when communicating with legislators who need evidence-based justification for reform votes.
The Shortlist
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Cigna's Evernorth announced voluntary PBM transparency measures ahead of potential regulation, including quarterly reimbursement reports for network pharmacies.
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The White House included pharmacy access provisions in its rural healthcare executive order, directing HHS to evaluate PBM network adequacy in underserved areas.
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PSAO consolidation continued as two regional organizations merged, creating a 3,500-pharmacy buying and contracting cooperative.
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Mark Cuban testified before a Senate subcommittee on drug pricing, advocating for transparent pharmacy benefit models.
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The American Medical Association joined pharmacy organizations in supporting PBM transparency legislation, broadening the reform coalition.