2 chapters across the catalog
An interim FTC report alleges that PBMs aggressively steer patients toward high-cost specialty drugs and preferred pharmacies to maximize profits. For example, a generic leukemia drug costing $66 was reimbursed at $2,700. Former FDA Commissioner Scott Gottlieb explains how the "back-ended rebate" system allows PBMs and insurers to profit while patients pay high out-of-pocket costs at the pharmacy counter.
Pharmaceutical companies are using complex rebate structures to force insurance companies to cover weight-loss drugs. By rebranding diabetes medications like Mounjaro as Zepbound for weight loss, manufacturers can leverage portfolio requirements. If an insurer wants the rebate for the diabetes version, they are often pressured to also cover the more expensive weight-loss version, turning the obesity epidemic into a high-stakes financial game.
