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.”
“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.