FTC Hearing Recap
A Pivotal Moment for PBM Accountability
The FTC hearing held on July 23rd has marked a significant milestone toward greater accountability and transparency in the PBM industry. Top executives from CVS Caremark, Optum Rx, and Express Scripts were present, collectively controlling approximately 80% of the US prescription market. The hearing highlighted the critical need for stringent reporting requirements, restrictions on PBM-owned pharmacies, and measures to prevent anti-competitive practices. This is a momentous development for taxpayers and patients who could benefit from lower drug costs and improved access to medications.
The ongoing investigation into the PBM industry's practices underscores the importance of fair business practices, and ProCare Rx is at the forefront of advocating for these changes.
Overview of the FTC Hearing
The FTC hearing focused on addressing the concentration of power among the major PBMs and their influence on drug prices. The key points discussed included the imbalance of power, consolidation of the market, and the impact on smaller pharmacies and consumers. The FTC expressed concerns over the lack of transparency in how PBMs negotiate rebates and discounts, often limiting access to cheaper generic alternatives. The hearing underscored the need for regulations to ensure fair competition and to protect consumer interests. As Chairman James Comer (R-KY) states:
“Since 2021, the Committee has made it a priority to expose harmful PBM practices and advance legislative solutions to ensure greater transparency and accountability in the PBM industry. Instead of prioritizing the health of Americans across the country, evidence obtained by the House Oversight Committee shows how the three largest pharmacy benefit managers colluded to line their own pockets.”
Impact on the PBM Industry
The hearing's outcome could lead to significant changes in the PBM landscape. Potential regulations could enforce transparency and accountability, requiring PBMs to report their practices more openly. This would benefit taxpayers and patients by potentially lowering drug costs and improving access to necessary medications. The industry may see a shift toward more ethical practices, aligning with ProCare Rx's long-standing commitment to transparency.
ProCare Rx's Position and Commitment
ProCare Rx has always operated with a focus on transparency and pass-through pricing, managing care and costs with the patient and sponsor at the center. Our Chief Growth Officer, Doyle Jensen, emphasizes that ProCare Rx has consistently prioritized fair business practices. "Over 30 years ago when ProCare Rx was founded, it was 'transparent and pass-through'. This is one of the most exciting times for the PBM industry. The exposure that is unfolding shows that the main players are not focused on managing a prescription benefit for the patient or the sponsor, but for their profitability. We at ProCare Rx will always focus on managing care and cost with the patient and sponsor at the nexus."
ProCare Rx also takes security and system uptime seriously, with no breaches or downtimes, setting a high standard in the industry. Our business model is built on principles that differentiate it from major PBMs:
- Lowest Net Cost with High Efficacy: We save our clients millions of dollars annually by focusing on the lowest net cost formulary.
- Transaction-Based Compensation: We offer transparent and fair pricing models, ensuring clients pay exactly what the pharmacy charges without hidden spreads.
- No Ownership of Pharmacies: Our independence ensures that we do not mandate high-cost prescriptions through our mail order, leading to significant savings.
- Cost Savings Programs: We consistently achieve optimal outcomes for our clients through innovative cost-saving programs.
- Direct Source Technology: Our direct-source system allows us to account for every dollar of drug spend -- something most other PBMs can’t claim. We control our entire process, allowing us to oversee every step and provide you with accurate data and representation.
The FTC hearing represents a positive step toward reforming the PBM industry. At ProCare Rx, we are optimistic about the future and remain committed to leading the industry with transparency, fairness, and a patient-centric approach. We invite clients and stakeholders to engage with us to discuss the potential changes in the PBM industry and how ProCare Rx can help navigate these changes and optimize their benefits. Together, we can achieve a more accountable and efficient PBM landscape.
About ProCare Rx
ProCare Rx is a privately held, independent pharmacy benefit manager (PBM) that has empowered healthcare and self-insured organizations since 1988. We provide fully integrated, in-house solutions—including claims adjudication, clinical program design, pharmacy network access, cost containment, and data analytics—all supported in the U.S. Our flexible, transparent model serves self-insured employers, third-party administrators (TPA), brokers, health plans, health systems, managed care organizations (MCO), unions, workers’ compensation programs, Medicare, Medicaid, hospices, and other PBMs. With a proprietary technology platform, commitment to ethical operations, and a focus on lowest net cost, ProCare Rx delivers long-term value, clinical performance, and trusted pharmacy benefit partnerships.
Media Contact:
Marc Cohen, VP, Marketing and Sales
marketing@ProCareRx.com
