Antitrust at the Agencies: PBM Madness at the FTC, Part 1
The Federal Trade Commission (FTC) announced Sept. 20 that it had filed a complaint:
against the three largest prescription drug benefit managers (PBMs)—Caremark Rx, Express Scripts (ESI), and OptumRx—and their affiliated group purchasing organizations (GPOs) for engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs, impaired patients’ access to lower list price products, and shifted the cost of high insulin list prices to vulnerable patients.
The commission later posted a redacted version of the complaint—which is partly a competition complaint but not, apparently, an antitrust complaint. It’s a pure Section 5 (of the FTC Act) complaint that’s one part competition and two-parts consumer protection. Concerns about competition in the health-care sector are legitimate–important, even. If we focus on price, safety, and effectiveness of and access to prescription drugs, one might have any number of policy concerns—including, but hardly limited to, antitrust concerns—about entities or conduct anywhere along the chain of development, marketing, and distribution. But the FTC complaint is a puzzle.