FTC releases second interim staff report on prescription drug middlemen: Report finds PBMs charge significant markups for cancer, HIV, and other critical specialty generic drugs

FTC releases second interim staff report on prescription drug middlemen: Report finds PBMs charge significant markups for cancer, HIV, and other critical specialty generic drugs
FTC press release; by FTC staff; 1/14/25
Staff’s latest report found that the ‘Big 3 PBMs’—Caremark Rx, LLC (CVS), Express Scripts, Inc. (ESI), and OptumRx, Inc. (OptumRx)—marked up numerous specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent, and many others by hundreds of percent. Such significant markups allowed the Big 3 PBMs and their affiliated specialty pharmacies to generate more than $7.3 billion in revenue from dispensing drugs in excess of the drugs’ estimated acquisition costs from 2017-2022. The Big 3 PBMs netted such significant revenues all while patient, employer, and other health care plan sponsor payments for drugs steadily increased annually, according to the staff report. Key Findings include:

• Significant price markups
• Dispensing the most profitable drugs
• Over $7.3 billion of dispensing revenue in excess of NADAC
• Generating additional income via spread pricing
• Plan sponsor and patient drug spending increased significantly