APCI to Feds: Stop Further Healthcare Vertical Integration in Optum-Amedisys Deal

Author: APCI Staff/Thursday, October 19, 2023/Categories: APCI News, Legislative Affairs

The federal government should prevent UnitedHealth Group’s Optum division from acquiring Amedisys home health, according to a letter from American Pharmacy Cooperative, Inc. (APCI) to the U.S. Department of Justice.

APCI opposes the acquisition as it represents “a further descent into an already vertically integrated healthcare supply chain in which the largest insurers and their affiliated pharmacy benefit managers are able to profit off conflicts of interest and misaligned incentives,” APCI Director of Healthcare Policy and General Counsel Reybold wrote in the Oct. 18 letter.

The letter also urges the Justice Department to consider potential unfair methods of competition under Section 5 of the Federal Trade Commission Act in addition to traditional antitrust analysis as it reviews the acquisition.

“The implications of insurers and pharmacy benefit managers (PBMs) owning prescribers and potentially controlling what procedures are ordered and what drugs are prescribed is chilling.”

Greg Reybold, APCI

“The implications of insurers and pharmacy benefit managers (PBMs) owning prescribers and potentially controlling what procedures are ordered and what drugs are prescribed is chilling,” Reybold said. “Traditional merger analysis has failed to prevent insurers from owning or being owned by PBMs and has failed to stop PBMs from owning pharmacies, and now it is allowing acquisitions of prescriber and home health entities by large insurers and PBMs. America’s healthcare system is at stake and the DOJ and FTC need every tool at their disposal to protect Americans from these practices and Section 5 of the FTC is one of those tools.”

In the letter, Reybold referenced studies from several governmental agencies including a recent MedPAC report that found vertical integration resulted in higher costs to seniors in Medicare Part D; that PBMs often paid their vertically integrated pharmacies more than non-affiliated pharmacies; and that PBMs denied Medicare Part D beneficiaries $50 billion in drug maker rebates at the pharmacy counter in 2021 alone.

The letter also focused heavily on rebate practices of vertically integrated PBMs and their role in rising prices for patients in urging scrutiny of the acquisition.

 “[L]arge PBMs are using their market power and restrictive formulary practices to drive drug maker rebate revenue, deprive beneficiaries of the benefit of drug maker rebates/discounts at the pharmacy counter, drive beneficiaries to purchase more expensive brand name drugs, and in many cases charging beneficiaries cost shares that exceed the net price of the drugs after rebates,” the letter stated.

“APCI has been one of the loudest and most consistent voices in opposing further vertical and horizontal integration by large insurers and their affiliated PBMs,” said APCI CEO Tim Hamrick.  “Community pharmacists have seen first-hand what vertical integration has done in pharmacy and the burden it has caused patients. APCI is committed to advocating on behalf of patients and the community pharmacies that serve them against further large insurer/PBM integration before agencies, U.S. Congress, and in the states.”

About APCI

APCI is a cooperative of more than 1,600 independently owned community pharmacies in 31 states. Established in 1984 and headquartered in Bessemer, Ala., APCI is recognized as a leader in the fight for prescription drug pricing transparency and reform. APCI’s advocacy team includes long-time Director of Legislative Affairs Bill Eley; Director of Healthcare Policy and General Counsel Greg Reybold; and the Government Affairs team at Arent Fox.

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