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.  

 

Recent Testimony:

Amicus Briefs:

  • 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.

White Papers:

Recent Federal and State Litigation:

Articles: