Video: Legislation, FTC Interim Report Positive Progress in Fight for PBM Reform

Faced with an industry in flux and a health care landscape dominated by the “Big 3” pharmacy benefit managers (PBMs) who control 90% of the market, Steven C. Anderson, FASAE, CAE, IOM, knows how important state- and federal-level advocacy is.

“We’ve helped enact 150 new laws over the last 3 years,” Anderson, president and CEO of the National Association of Chain Drug Stores (NACDS), said. “We’re working with Capitol Hill on this issue, and at the regulatory [level].” He spoke with Drug Topics during the 2024 NACDS Total Store Expo, held August 17 to August 19, 2024, in Boston, Massachusetts.

READ MORE: In July, PBMs Found Themselves in the Federal Government Hot Seat

According to Anderson, PBMs are forcing pharmacies to accept contracts he describes as “untenable.” “PBMs have been hiding behind this complexity—the opaqueness—of the industry, of people not understanding it, and now people are beginning to understand.”

He also addressed the Federal Trade Commission (FTC) investigation into PBM practices. The ongoing investigation began in 2022, and the agency released a 71-page interim report on July 9, 2024. In it, the FTC outlined the ways in which the “Big 3” PBMs—a group that includes CVS Caremark, Optum Rx, and Express Scripts—operate in a manner that hurts the sickest patients and squeezes out small competitors.¹ On July 23, executives from the Big 3 were called before the House Oversight and Accountability Committee to answer questions from a bipartisan group of lawmakers around rising drug costs, anticompetitive practices, and prior authorization requirements. These lawmakers, Anderson said, have begun to understand PBMs on a level that they had not understood previously. “Try to tell a member of Congress what a direct and indirect remuneration fee is, and what a PBM is… Now they get it.”

“As their understanding deepens, their voices rise, their eyes kind of light up, saying ‘We’re going to fix this, because it’s not good for our country,” Anderson said.

Ready to catch up on the rest of our conference coverage? Click here for more of our coverage] of the 2024 NACDS Total Store Expo.

Reference

1. Caffrey M. In July, PBMs found themselves in the federal government hot seat. Drug Topics. August 5, 2024. Accessed August 19, 2024. https://www.drugtopics.com/view/in-july-pbms-found-themselves-in-the-federal-government-hot-seat