FTC Report Reveals Big 3 PBMs Made $7.3 Billion from Excessive Markups on Specialty Generic Drugs

Significant Price Markups:
The Big 3 PBMs (Caremark Rx, LLC, Express Scripts, Inc., and OptumRx, Inc.) imposed markups of hundreds and thousands of percent on numerous specialty generic drugs dispensed at their affiliated pharmacies, including drugs used to treat cancer, HIV, and other serious diseases1 2 4.

Revenue Generation:
These 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 to 20221 2 3.

Growth Rate:
The revenue from dispensing these drugs in excess of their estimated acquisition cost grew at a compound annual growth rate of 42 percent1.

Steering Prescriptions:
The Big 3 PBMs may be steering highly profitable prescriptions to their own affiliated pharmacies, away from unaffiliated pharmacies, as indicated by the disproportionate share of commercial prescriptions for specialty generic drugs marked up more than $1,000 per prescription dispensed by affiliated pharmacies1 4.

Impact on Healthcare Costs:
The total cost of prescription drugs has increased from $393 billion in 2016 to $600 billion in 2023, with plan sponsor payments growing at a compound annual growth rate of 21 percent for commercial claims5.

Regulatory Attention:
The FTC's findings have sparked regulatory attention and criticism, with calls for policymakers to address the issue and ensure affordable, accessible healthcare1 3 5.