The Federal Trade Commission’s (FTC) latest smackdown on pharmacy benefit managers (PBMs) is a doozy, and it paints a picture we know all too well: big corporations siphoning billions while patients get left holding the bag.
In their second interim report, the FTC zeros in on the “Big 3” PBMs—Caremark (CVS), Express Scripts, and OptumRx—exposing some eye-popping numbers. These middlemen are marking up specialty generics like cancer and HIV drugs by hundreds, even thousands of percent. We’re talking $7.3 billion in excess revenue from 2017 to 2022, with markups driving costs higher every year.
But here’s where it hits home for our community: the same tactics they use to gouge cancer patients are at play with obesity medications. The same barriers, the same inflated costs, the same profit-driven schemes. And while PBMs laugh all the way to the bank, 100 million Americans with obesity are left to fend for themselves in a system designed to bleed them dry.
Breaking Down the PBM Playbook
The FTC report reads like a highlight reel of PBM shenanigans:
• Massive markups: Specialty generics are being marked up by up to 1,000% or more at PBM-affiliated pharmacies. The game is simple—PBMs control the pharmacy networks and steer the most profitable drugs into their own pockets.
• Spread pricing: PBMs billed clients far more than they reimbursed pharmacies, raking in another $1.4 billion on specialty generics alone.
• Independent squeeze-out: PBMs reimburse their own pharmacies at higher rates than unaffiliated ones, effectively starving out the competition.
• Patient costs on the rise: Plan sponsors and patients shelled out $5.1 billion for specialty generics in 2021, with patient cost-sharing alone hitting nearly $300 million.
In short, it’s a system rigged to funnel money up the chain while patients and employers are stuck footing the bill.
The Obesity Connection
The FTC’s findings echo what we’ve been screaming from the rooftops: PBMs are one of the biggest barriers to affordable access for GLP-1 medications and other anti-obesity treatments. These drugs aren’t just expensive because they’re cutting-edge; they’re expensive because PBMs make them expensive.
Here’s the kicker: this kind of profiteering is keeping life-changing medications out of reach for millions. Patients who could avoid surgery, hospitalizations, and comorbidities are instead forced to navigate formularies designed to fail them. If you’ve ever fought through a prior authorization or been denied outright, this is why.
PBM Reform: Why It Matters and What’s Next
If there’s one thing this report makes clear, it’s that #PBMReform isn’t just overdue—it’s a moral imperative. The FTC is doing its part by investigating and exposing the problem, but the real change has to come from lawmakers and regulators stepping up to rein in PBMs.
What does reform look like?
• Price transparency: Patients and plan sponsors need to know what they’re paying for and why.
• Leveling the playing field: Stop letting PBMs steer the most profitable drugs to their own pharmacies.
• Access over profits: Prioritize affordability and accessibility over bloated markups and backdoor deals.
For those of us in the obesity advocacy space, this means fighting to make sure GLP-1 medications aren’t just for the privileged few. It means demanding that these drugs be treated as essential, not optional.
What You Can Do
The FTC’s report is ammunition in the fight for reform, but it’s up to us to take the next step.
• Call your representatives. Tell them you want real PBM reform that lowers drug costs for patients.
• Share your story. Let the world know how PBM practices have impacted your ability to access the care you need. Make sure to use the hashtags #onthepen and #pbmreform.
• Stay informed. Follow the latest on PBM reform and obesity treatment news here at On The Pen.
The time for change is now. PBMs have had their day in the sun, and it’s high time patients got a fair shot.
Stay loud, stay informed, and let’s keep the pressure on. Together, we can make it happen.
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