FTC finds PBMs charge significant markups for specialty generics

15 January 2025

Several of the USA’s biggest pharmacy benefit managers (PBMs) have generated billions of dollars in revenue by charging “enormous mark-ups,” according to the competition regulator.

The Federal Trade Commission (FTC) yesterday published a second interim staff report on the prescription drug middleman industry, which focuses on PBMs influence over specialty generic drugs, including significant price markups by PBMs for cancer, HIV, and a variety of other critical drugs.

Specifically, the report found that the ‘Big 3 PBMs’ - Caremark Rx, Express Scripts, and OptumRx - marked up numerous specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent, and many others by hundreds of percent. Such significant 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 2022.

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