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FTC Launches Investigation of Harlem Drug Benefit Managers in Hollywood – Harlem World Magazine



The Federal Trade Commission (FTC) has launched an investigation into Pharmacy Benefit Managers (PBMs) in an effort to reduce prescription drug costs for consumers.

The survey targets the six largest PBMs and requires them to provide information and records that inform their business practices.

The survey will try to determine how these marketing practices affect the prices consumers pay for prescription drugs, either out of pocket or through higher insurance premiums.

The companies surveyed are:

  • CVS Care Mark
  • ExpressScripts, Inc.
  • OptumRx, Inc.
  • human inc.
  • Prime Therapeutics LLC
  • MedImpact Healthcare Systems, Inc.

Intermediaries between drug manufacturers and pharmacies

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Pharmacy benefit managers serve as intermediaries between drug manufacturers and retail pharmacies.

The industry has defended itself against accusations that it is largely responsible for high drug costs, saying the focus should be on the pricing policies of big pharma.

Although many people have never heard of drug benefit managers, these powerful intermediaries have a huge influence on the US prescription drug system, said FTC Chairman Lina Khan. This study will shed light on the practices of these companies and their impact on pharmacies, payers, physicians and patients.

The role of PBMs in the nations healthcare system is to negotiate discounts and fees with drug manufacturers, create drug formularies and related policies, and reimburse pharmacies for patient prescriptions.

According to the FTC, the nation’s largest PBMs are now vertically integrated with the largest health insurance companies and wholly-owned mail-order and specialty pharmacies.

What consumers are saying

Consumers who review these companies on ConsumerAffairs rarely mention drug prices, but often express frustration with the effectiveness of various companies. Luciano, from Newtown, Pennsylvania, told us that communication is an issue with Express Scripts.

I’ve been on the phone with Express Scripts and Cigna Medicare 6 times in the last 30 days, 4 just today holding some capacity for 4 hours, Lucianowrotein a ConsumerAffairs magazine. My doctor sent a prescription to an address given to him and after 10 days I had not received my medication. Today I called Express Scripts, who transferred me to Cigna, who transferred me to Cigna Medicare, who transferred me to Express Scripts. After explaining my situation several times, sometimes twice to the same person, I received 4 different addresses where the prescriptions had to be sent.

Of the six PBMs investigated by the FTC, consumer affairs reviewers give them these ratings, based on a 5-star system:

The Pharmaceutical Care Management Association (PCMA), a major PBM trade group, called two weeks ago for an expanded investigation into high drug prices.

Thisexpressed supportfor pending Senate legislation that addresses drug pricing and said the entire pharmaceutical industry should come under scrutiny.

Photo credit: CVS in Harlem.

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“Dr. Harry Delany is a renowned surgeon born and raised in Harlem, the son of the great jurist and civil rights leader, Hubert Delany….” This monthly post is written in Partnership with Harlem Cultural Archives.




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