What did the FTC's broader PBM investigation find?
The big three PBMs process 80% of US prescriptions; affiliated pharmacies earned ~$1.6 billion in excess revenue on two cancer drugs in under three years; and PBMs generated $7.4 billion by marking up 51 specialty generics — while nearly 30% of Americans reported rationing doses.
Alongside the insulin case, the FTC conducted a wider study of PBMs. Its July 2024 interim report found the three largest PBMs processed about 80% of the 6.6 billion prescriptions filled in 2023, and the six largest nearly 95%. It highlighted vertical integration with insurers and pharmacies, noting that pharmacies affiliated with the big three accounted for nearly 70% of specialty drug revenue, and found affiliated pharmacies earned nearly $1.6 billion in excess revenue on just two cancer drugs in under three years. A second report found the PBMs generated gouging/" target="_blank" rel="noopener noreferrer" class="article-link">$7.4 billion by marking up prices of 51 specialty generic drugs between 2017 and 2022. Nearly 30% of Americans surveyed reported rationing or skipping doses because of cost. The findings supported the argument that PBM incentives, not only manufacturer pricing, shape what patients pay.