Judge denies PBM motion to stop FTC lawsuit


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A judge has denied a request by pharmacy benefit managers named in a Federal Trade Commission complaint to prevent the case from moving forward.
Judge Matthew T. Schelp in the Eastern District of Missouri has denied the PBMs‘ preliminary relief but said this does not mean that the plaintiffs will be unable to obtain any relief “when all is said and done.”
WHY THIS MATTERS
On Sept, 20, 2024, the FTC filed an administrative complaint against the three largest PBMs – Caremark Rx, Express Scripts and OptumRx – and their affiliated group purchasing organizations for allegedly engaging in anticompetitive and unfair rebating practices that artificially inflated the list price of insulin drugs.
The PBMs filed for a preliminary injunction, saying the FTC violated the Constitution in four different ways, including that the FTC’s administrative law judge overseeing the proceeding is unlawfully insulated from removal.
The federal district court in Missouri denied all four reasons and said the PBMs failed to show a sufficient threat of irreparable harm warranting preliminary relief.
The court also cited “the balance of the equities and public interest” as a reason for the denial.
THE LARGER TREND
PBMs negotiate with drug manufacturers on what plans will pay for drugs, maintaining they secure discounts that plans pass on to patients.
However, the FTC maintained that PBMs systematically prefer high list price insulin products with high rebates and fees over low list products.
Some of them, according to FTC documents, “had unfairly created and implemented a system of rebates and exclusionary formularies that shifts the cost of high insulin list prices to certain patients,” in violation of law.
Companies named in the case as respondents include Caremark, Zinc Health Services, Express Scripts, Evernorth, Medco Health Services, Ascent Health Services, OptumRx, OptumRx Holdings and Emisar Pharma Services.
Email the writer: SMorse@himss.org