Opinion: Prior authorization requirements harm patients and physicians; FTC must look into drug delaying practice

In June, the Federal Trade Commission (FTC) announced they will be launching an inquiry into the practices of the “prescription drug middleman” industry. These middlemen, known as Pharmacy Benefit Managers (PBMs), determine if an insurer will pay for a prescription that is prescribed for a patient. Caremark, ExpressScripts and Optum are some of the familiar gatekeepers and suppliers of medications. The FTC statement reads, “Pharmacy benefit managers are the middlemen who are hired to negotiate rebates and fees with drug manufacturers, create drug formularies and surrounding policies, and reimburse pharmacies for patients’ prescriptions. The largest pharmacy benefits managers are now vertically integrated with the largest health insurance companies and wholly owned mail order and specialty pharmacies.”