Alan J. Arville, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, was quoted in Law360 Healthcare Authority, in “A Look at the Real Impact of the FTC's PBM Settlements,” by Yeji Jesse Lee. (Read the full version – subscription required.)
Following is an excerpt:
In February, the FTC and Express Scripts announced a major settlement that would impose "fundamental changes" to Express Scripts' drug formulary practices, putting to rest a case the FTC had brought against the company in 2024 that accused it, and other PBM giants, of inflating insulin prices through rebate schemes.
According to Section 11a of the settlement, Express Scripts can offer different terms than the "Standard Offering" created by the settlement as long as it makes the standard option available to health plan sponsors who can effectively ask for, and receive, something different.
That loophole could effectively make this settlement "more bark than bite," said Alan Arville, a healthcare attorney at Epstein Becker Green, who said that he expects some plan sponsors could keep the status quo. ...
It's unclear how many plans will actually opt to do that. But Arville said that some terms in the standard offering could increase a plan's administrative costs and potentially push premiums higher.
"It's really going to be item by item," he added. While plan sponsors may appreciate the detailed transparency and disclosure requirements in the standard offering outlined in the Express Scripts settlement, they may be less enthusiastic about other elements - such as requiring rebates to be passed through to members at the point of sale - which could raise administrative costs.
