Shocking revelations from a Federal Trade Commission, or FTC, investigation have exposed how three major prescription benefit managers, or PBMs, systematically inflated medication costs, disproportionately affecting communities already struggling with health care access. The investigation — completed in 2022 — places OptumRX, Express Scripts and CVS Caremark Rx under intense scrutiny for practices that have devastated families managing chronic conditions.
The billion-dollar markup game
The investigation uncovered a staggering $7.3 billion profit generated through excessive medication markups by these three companies. The FTC’s report details how these PBMs strategically steered patients toward their affiliated pharmacies, where prescription costs often exceeded those at independent pharmacies by more than $1,000.
This systematic markup particularly impacts neighborhoods where independent pharmacies have historically served as trusted community health care resources. These local businesses now face unprecedented challenges competing against the pricing tactics of major corporations.
The investigation revealed a troubling pattern where medications for serious conditions like leukemia, cardiac hypertension and HIV faced markups of up to four times their actual cost. This pricing strategy has created an additional burden for families already navigating complex health care challenges, often forcing impossible choices between essential medications and other basic needs.
A system designed to profit, not protect
The three PBMs have attempted to defend their practices, with CVS Caremark leading the charge by suggesting the FTC promotes an anti-PBM agenda. Their stance implies that any policy changes would result in higher drug prices for patients managing ongoing medical conditions. OptumRX, under UnitedHealth’s ownership, maintains they provide cost-effective solutions for complex health needs, particularly regarding specialty medications that comprise half of all drug expenditures.
These corporate defenses ring hollow against the backdrop of communities struggling to maintain consistent access to lifesaving medications. The practice of steering patients to affiliated pharmacies has created health care deserts in areas where independent pharmacies once thrived, further limiting options for those seeking affordable medication.
The situation intensified following recent events at UnitedHealth, including the death of CEO Brian Thompson. The incident — which involved alleged shooter Luigi Mangione and his criticism of the health care system — has amplified conversations about corporate accountability in health care.
Breaking the cycle
The FTC’s findings represent more than just corporate malpractice; they expose a systemic issue that has long plagued American health care. For communities that have historically faced barriers to health care access, these revelations confirm long-held suspicions about institutional practices that prioritize profit over public health.
This investigation marks a crucial step toward dismantling a system that has allowed corporations to exploit vulnerable populations through inflated medication costs. As regulatory bodies continue their scrutiny, the focus must remain on creating equitable access to affordable medications and supporting independent pharmacies that serve as vital community resources.
The path forward requires sustained pressure on these corporations to reform their practices and implement transparent pricing strategies. Until then, millions of Americans will continue facing impossible choices between their health and financial stability, perpetuating a cycle of health care inequality that has persisted for far too long.
