Pharmacy Benefit Manager Antitrust
Pharmacy Benefit Managers (PBMs) can play an important function in health care markets by
setting up pharmaceutical networks and adjudicating pharmaceutical claims.
Serving as brokers for plans between pharmaceutical manufacturers and
retailers, PBMs have significant potential to control pharmaceutical costs.
Yet, this market often does not function effectively because of a lack of
competition and transparency. The tremendous consolidation and total
regulatory neglect of this market have prevented plans and employers from
receiving the full benefits from these PBMs. In addition, each of the
major PBMs have been subject to major enforcement actions securing over $370
million in penalties and fines.
Our office has been at the
forefront of efforts to battle egregious, deceptive and anticompetitive conduct by some PBMs. We have
represented health plans, employers, unions, pharmacies, consumer
groups, and PBMs on various competition issues.
As Policy Director at the FTC, David Balto was
instrumental in bringing some of the first enforcement actions against major
PBMs. Our office frequently objects to proposed PBM mergers including AdvancePCS/Caremark,
Express Scripts/Caremark and Express Scripts/Wellpoint and authored seminal
white papers on the mergers. David Balto often testifies in
front of state legislatures and congressional committees on the cost-saving
potential of greater transparency and regulation in the PBM market and has been
an expert witness in PBM litigation.
- David Balto's Testimony on Anti-Mail Order Legislation, Before the Hawaii Legislature. April 12, 2013.
- David Balto's Testimony on PBM MAC Legislation, Before the North Dakota Legislature. March 25, 2013.
- David Balto's Testimony on Health Industry Consolidation, Before the House Committee on Ways and Means, Subcommittee on Health. September 9, 2011.
- David Balto's December 2010 testimony before the Department of Labor on the benefits of PBM transparency.
- David Balto's February 2010 testimony before the Ohio Senate Insurance, Commerce and Labor Committee addressing the increasing problem of the ownership of pharmacy benefit managers, PBMs, by pharmacy chains.
- David Balto's July 2009 Testimony before the Consumer Protection, Product Safety and Insurance Subcommittee of the Senate Committee on Commerce, Science and Transportation on “Competition in the Health Care Marketplace” -- "The Effects of Regulatory Neglect on Health Care Consumers."
- David Balto's Testimony before the House Judiciary Committee, Antitrust Task Force. October 18, 2007. "The Impact of our Antitrust Laws on Community Pharmacies and Their Patients."
- The Muecke Company, Inc., et al v. CVS Caremark, et al (United States District Court for the Southern District of Texas). Amicus brief on behalf of the National Community Pharmacists Association opposing CVS Caremark's motion to compel arbitration.
- The Muecke Company, Inc., et al v. CVS Caremark, et al (United States District Court for the Southern District of Texas). Amicus brief on behalf of consumer organizations Consumer Federation of America, National Legislative Association on Prescription Drug Prices and U.S. PIRG in opposition to CVS Caremark's motion to compel arbitration.
Recent Federal and State Litigation: