If you’ve been wondering why your prescription costs more than your monthly rent, the Federal Trade Commission just dropped a zesty little nugget that might make you want to flip a table. According to the FTC’s latest report, pharmacy benefit managers (PBMs)—a.k.a. The “wolves in sheeps clothing” middlemen who are supposed to lower drug prices—have been playing the system harder than a teenager with a GameShark in 1999.

(Source: Giphy) 

Between 2017 and 2022, the Big Three PBMs—CVS Caremark, Cigna’s Express Scripts, and UnitedHealth’s OptumRx—raked in $7.3 billion by marking up prices on specialty generic drugs. And we’re not talking a little padding here and there. Nah, these guys inflated prices by “hundreds or even thousands of percent” on life-saving meds for things like cancer, HIV, and heart disease. So yeah, while you’re out here rationing insulin or choosing between groceries and your Lipitor, these guys are cashing in like they’re starring in a pharmaceutical version of The Wolf of Wall Street.

Here’s how it works: PBMs are supposed to negotiate with drug companies to lower costs for patients, insurers, and employers. Instead, the FTC found that the Big Three were reimbursing their own affiliated pharmacies at jacked-up rates way higher than unaffiliated, independent ones. It’s like giving your cousin a fat raise for selling lemonade at a 500% markup while telling the neighborhood kids they’re lucky to break even.

(Source: CNN) 

Now this isn’t just a one-off scam. The report reveals that PBMs process a staggering 80% of all prescriptions in the U.S.—basically, they’re the gatekeepers of your medicine cabinet. And instead of using that power for good, they’ve been lining their pockets by steering business to their own pharmacies and inflating prices. Cancer drugs alone accounted for half of the $7.3 billion in markups, because apparently, nothing screams “profit opportunity” like a patient fighting for their life.

But, but, but… keep in mind, this has been an ongoing issue for the FTC. Last year, the agency dragged PBMs for inflating insulin prices and squeezing independent pharmacies out of the market. Express Scripts even tried suing the FTC for calling them out, which went about as well as you’d expect. Now, with this latest report, the heat is back on, and it’s looking like the PBM industry might finally be getting the regulatory slap it’s been begging for.

(Source: NBC News) 

What’s more is that researchers, advocates, and #47 (President Trump) have been railing against the “horrible middleman” for quite awhile now. Whereas, Trump  called PBMs out for “making more money than the drug companies” while adding zero value. And honestly? He wasn’t wrong.

Simply put, the FTC’s report didn’t just expose the PBMs’ business tactics; it also highlighted their sheer dominance in the market. With their control over pricing and distribution, these companies have essentially turned the prescription drug market into their personal Monopoly board—and surprise, surprise…  you’re not the one buying hotels on Park Place.

(Source: Giphy) 

Looking ahead, regulators are now under immense pressure to actually do something about this mess (think stick up for its citizens they serve). The FTC has already sued the Big Three for anticompetitive practices, accusing them of artificially inflating prices on critical meds like insulin. But with billions of dollars at stake and some of the nation’s largest companies involved, this fight isn’t going to be a quick one. [Insert Tinfoil Hat conspiracy here LOL] 

For now, all we’ve got is this: a detailed report confirming what most of us already suspected—PBMs are playing dirty, and patients are the ones paying the price. So next time you pick up a prescription and feel your wallet cry, remember: the middleman’s yacht probably just got a little bigger… *sigh*.

As always, do what you will with this information and stay safe and stay frosty, friends! Until next time… 

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