The U.S. Justice Department's Antitrust Division is launching an investigation into health care conglomerates and pharmacy benefit managers (PBMs) for potential anticompetitive practices. This announcement was made by Doha Mekki, Principal Deputy Assistant Attorney General, on October 31, 2024. The investigation comes amid ongoing scrutiny of PBMs, which control access to 80% of insured patients and have been linked to rising drug costs and the closure of community pharmacies [384084ee].
In parallel, the Federal Trade Commission (FTC) is also investigating PBMs, particularly focusing on their pricing practices regarding insulin. The FTC's report alleges that major PBMs, including UnitedHealth Group's OptumRx, Cigna Group's Express Scripts, and CVS Health's Caremark, have been inflating medication prices while steering customers away from cheaper alternatives. The FTC's investigation was initiated in 2022 and has revealed practices where PBMs rank drugs on formularies to influence customer choices, often excluding cheaper medications in exchange for larger rebates from drug manufacturers [dfce12cb].
The FTC's lawsuit against these PBMs is part of a broader effort to address the rising costs of medications, which have led to approximately 30% of Americans rationing or skipping doses of their prescriptions. The outcome of this lawsuit could significantly impact the pricing practices of PBMs and the accessibility of medications for consumers [dfce12cb].
Additionally, the Justice Department has recently charged nearly 200 individuals, including healthcare professionals, with participating in healthcare fraud schemes worth $2.7 billion. This initiative is part of ongoing efforts to combat healthcare fraud and protect the integrity of the healthcare system [477fe8b3].
Mekki emphasized the importance of a comprehensive approach to antitrust enforcement in the healthcare sector, which constitutes 20% of the U.S. GDP. The Antitrust Division has established a health care task force to address these issues and is actively seeking input from consumers to inform its investigations [384084ee].