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The Mafia of Pharma Pricing


4% of all the money in America flows through a few mafia-like health care conglomerates. The FTC just released a ground-breaking report on how they operate. And it is gearing up to sue.

PBMs are a topic I’ve covered, mostly as a cause of the disappearance of rural independent pharmacies, but last week, the FTC sparked a big political fight by releasing this report on the PBM business model. But in 1987, Congress passed an exemption to a Medicare Anti-Kickback statute, which created a safe harbor for group buying entities to accept payment from drug manufacturers in the form of rebates, with certain guardrails in place. “These kinds of discounts seem contrary,” it said, “to basic American precepts of justice, as they would “effectively end the value of publicly posted prices” and “favor the large organized interests with competitive alternatives at the expense of the unorganized, uneducated, or captive.” That’s the main policy recommendation to the most conservative Republican President since Herbert Hoover.

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