Five national pharmacy groups are urging the Federal Trade Commission to scrutinize megamergers in healthcare and expressed concern that they are negatively affecting pharmacists and their patients.
In a letter sent to the FTC Feb. 26, the groups said consolidation in healthcare has "yielded significant anticompetitive effects without promised improvements in cost or quality."
The three largest pharmacy benefit managers in the U.S. control more than three-fourths of all prescriptions filled in the U.S., and each has been combined with other, equally powerful healthcare companies, they said.
They cited the CVS acquisition of Aetna, Cigna's acquisition of Express Scripts and OptumRx's affiliation with UnitedHealthcare as examples of the type of mergers that pose risks for pharmacies, pharmacists and the people they treat.
The two largest pharmacy chains in the U.S. have a 50 percent to 70 percent share of the country's largest markets, and that the largest four commercial health insurers have more than 8 percent of the country's commercial health insurance business.
"This surge in vertical consolidation has essentially created an oligopoly of integrated healthcare companies controlling nearly all aspects of the healthcare and pharmacy supply chain," the groups wrote.
As an example of the dangers consolidation presents, the groups wrote that a health insurer or PBM that merges with a large retail pharmacy chain could be tempted to exclude competing pharmacies from its preferred networks, lowering pharmacy access for people. They could also demand unsustainable reimbursement rates from competing pharmacies.
Consumer Reports determined that CVS pharmacies often have prices 400 percent higher than independent pharmacies for the same prescription drugs, despite claims of enhanced efficiencies and pro-competitive benefits of its merger with Aetna, the groups said.
The groups asked the FTC to consider renewed approaches to regulating consolidation, as current guidelines "fail to protect competition and healthcare consumers."
They asked the FTC to not presume that "theoretical efficiencies" of proposed mergers or acquisitions will offset an anticompetitive transaction.
Read the full letter here.