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After a two-year investigation into pharmacy benefit managers, the Federal Trade Commission has released an interim report, which argues that these “powerful middlemen” are inflating costs and “squeezing Main Street pharmacies.” 

As plan sponsors are required to attest that the fees they pay for health care plans are fair and reasonable for the services provided under the Consolidated Appropriations Act of 2021, it is important that plan sponsors apply a fiduciary process to evaluating their health plans, as well as being aware of pending litigation. 

The FTC is poised to file a lawsuit against the three largest PBMs—OptumRx (UnitedHealth Group), Caremark (CVS Health) and Express Scripts (Cigna Group), alleging they pushed patients to more expensive brand-name drugs, including insulin, four people familiar with the case discussions told media outlets this week. 

Plan sponsors often work with PBMs to administer health care benefits to their enrolled participants, and sponsors typically issue requests for proposals detailing their pharmacy benefits needs, to which PBMs respond and compete on quality, cost effectiveness and accountability, according to the Pharmaceutical Care Management Association.  

Once a plan sponsor selects a PBM, the plan sponsor and PBM negotiate contract terms and conditions. Plan sponsors “have every opportunity to choose a pricing model that best suits their needs,” according to the PCMA.