NPR – Millions of people with diabetes need insulin to survive. For years, many of them have been forced to pay exorbitant prices for a product that’s inexpensive to make.
Now, the federal government is targeting one part of the system behind high insulin prices.
While out-of-pocket costs have gone down for many people to $35 a month, questions remain on how the drug became so expensive in the first place.
In a new lawsuit filed Friday, the Federal Trade Commission said it’s going after one link in the chain: pharmacy benefit managers (PBMs).
The FTC brought action against the top PBMs — CVS Health’s Caremark Rx, Cigna’s Express Scripts, and United Health Group’s OptumRx — saying the companies created a “perverse drug rebate system” that artificially inflates the cost of insulin.
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“According to the suit, the PBMs collected billions of dollars in rebates and fees while insulin became increasingly unaffordable.”
If the suit is successful, it could further drive down costs for patients at the pharmacy counter.
PBMs are essentially the middlemen between drug manufacturers and insurance providers.
Their job is to reduce drug prices. But the process is complex and opaque, and critics say they’re actually driving prices up for patients.
The FTC said a big issue is that PBMs’ revenue is tied to rebates and fees — which are based on a percentage of a drug’s list price.
Essentially, in the case of insulin, when the drug costed more, it generated higher rebates and fees for PBMs.
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“Even when lower list price insulins became available that could have been more affordable for vulnerable patients, the PBMs systemically excluded them in favor of high list price, highly rebated insulin products,” the FTC said in a press release on Friday …