WASHINGTON, D.C. – Just one day after President Trump signed into law the most comprehensive pharmacy benefit manger (PBM) reform in American history, the Federal Trade Commission (FTC) reached a historic settlement with one of the nation’s largest PBMs, Express Scripts, Inc., along with affiliated entities (ESI collectively), requiring them to change current business practices to drive down drug costs for patients and employers.
The settlement directly addresses many of the harmful pharmaceutical middlemen practices that the House Committee on Energy and Commerce has called attention to for years and supports a key commitment of President Trump’s new health care agenda, The Great Healthcare Plan, to lower prescription drug prices.
Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, issued the following statement:
“This week has marked many successes when it comes to transparency and affordability of prescription drugs for American patients,” said Chairman Guthrie. “The House Committee on Energy and Commerce supports President Trump’s efforts and will continue this work by calling in representatives across the entire prescription drug supply chain next week to continue our commitment to lowering the cost of care for all Americans. This is just another way Republicans are working to implement meaningful relief for American families when it comes to health care affordability.”
Background:
ESI, under the FTC’s proposed consent order, has agreed to:
- Stop preferring on its standard formularies high wholesale acquisition cost versions of a drug over identical low wholesale acquisition cost versions;
- Provide a standard offering to its plan sponsors that ensures that members’ out-of-pocket expenses will be based on the drug’s net cost, rather than its artificially inflated list price;
- Provide covered access to TrumpRx as part of its standard offering upon relevant legal and regulatory changes;
- Provide full access to its Patient Assurance Program’s insulin benefits to all members when a plan sponsor adopts a formulary that includes an insulin product covered by the Patient Assurance Program unless the plan sponsor opts out in writing;
- Provide a standard offering to all plan sponsors that allows the plan sponsor to transition off rebate guarantees and spread pricing;
- Delink drug manufacturers’ compensation to ESI from list prices as part of its standard offering;
- Increase transparency for plan sponsors, including with mandatory, drug-level reporting, providing data to permit compliance with the Transparency in Coverage regulations, and disclosing payments to brokers representing plan sponsors;
- Transition its standard offering to retail community pharmacies to a more transparent and fairer model based on the actual acquisition cost for a drug product plus a dispensing fee and additional compensation for non-dispensing services;
- Promote the standard offerings to plan sponsors and retail community pharmacies; and
- Reshore its group purchasing organization Ascent from Switzerland to the United States, which will bring back to the United States more than $750 billion in purchasing activity over the duration of the order.
- The settlement is projected to ** save American patients $7 billion ** in out-of-pocket costs for prescription drugs over a decade.
Click HERE to read the full settlement.