SAVE YOUR LOCAL PHARMACIES!!!
Stop Unfair PBM Practices
We respectfully petition the Federal Trade Commission to take immediate enforcement action against Pharmacy Benefit Managers (PBMs) for unfair, deceptive, and anticompetitive practices that threaten patient access, destroy competition, and accelerate the closure of retail pharmacies nationwide.
Why We Are Asking for FTC Action Now
Retail pharmacies — both independent and chain — are closing at an alarming rate. These closures reduce access to medications, vaccines, and basic healthcare services for millions of Americans.
PBMs control drug pricing, pharmacy reimbursement, and patient access, yet they are not operating as neutral market participants. Instead, PBMs increasingly act as vertically integrated monopolies that profit by steering patients and money toward businesses they own or control.
Without immediate FTC intervention, many remaining retail pharmacies are at risk of disappearing within the next six months.
Core Unfair and Anti-competitive PBM Practices
We ask the FTC to investigate and act on the following practices, which appear to violate federal antitrust and consumer protection laws:
1. Paying Pharmacies Below Their Cost to Buy Medications
- PBMs routinely reimburse retail pharmacies less than the pharmacy’s acquisition cost.
- Some states have recognized this as harmful and have passed laws prohibiting reimbursement below purchase price.
- PBMs continue these practices elsewhere, forcing pharmacies to dispense medications at a loss, and occasionally within those same states with legislation preventing such practice (see recent Oklahoma settlement with CVS Caremark for such violations of over $5 million).
This is not competition — it is market destruction.
2. Self-Dealing Through PBM-Owned Mail-Order and Specialty Pharmacies
- Many PBMs own or have financial interests in mail-order and specialty pharmacies.
- These PBM-owned pharmacies are paid higher rates than unaffiliated retail pharmacies for the same medications.
- Patients are often forced or steered into PBM-owned pharmacies, even when a local pharmacy is available.
This is preferential treatment, not a free market.
3. Non-Negotiable, Take-It-or-Leave-It Contracts
- Retail pharmacies are required to accept non-negotiable contracts drafted entirely by PBMs.
- Pharmacies cannot negotiate reimbursement, fees, audit rules, or payment timelines.
- PBMs can change terms after contracts are signed, often without meaningful notice.
This imbalance of power removes real competition and violates fair dealing principles.
4. Lack of Transparency and Data Access
- PBMs refuse to fully disclose:
- How reimbursement rates are set
- How fees are calculated
- How much PBMs pay themselves or affiliated entities
- Pharmacies and regulators cannot access timely, complete data needed to challenge improper payments.
Markets cannot function when pricing and rules are hidden.
5. Steering, Clawbacks, and Retroactive Fees
- PBMs impose retroactive “clawback” fees months after prescriptions are filled.
- These fees are unpredictable, impossible to audit in advance, and financially devastating.
- Pharmacies are punished even when they follow all contract terms.
This creates financial instability by design.
Harm to the Public
These PBM practices do not benefit patients, employers, Medicare, or communities. Instead, they:
- Increase pharmacy closures and healthcare deserts
- Reduce medication access for seniors, rural residents, and low-income patients
- Increase long-term healthcare costs due to delayed or abandoned care
- Shift profits upward while eliminating local healthcare providers
This is monopoly behavior that benefits PBMs alone.
FTC Authority and Responsibility
We respectfully urge the FTC to use its full authority under federal law, including:
- Section 5 of the FTC Act (unfair methods of competition)
- Antitrust and monopoly enforcement powers
- Authority to require transparency, data submission, and ongoing oversight
- Authority to prohibit self-preferencing and below-cost reimbursement practices
The FTC has already recognized PBMs as a major area of concern. We ask the Commission to move from investigation to swift enforcement before further harm occurs.
Our Requests to the FTC
We formally request that the FTC:
- Immediately investigate PBMs for monopoly and anticompetitive conduct
- Prohibit reimbursement below pharmacy acquisition cost
- Require full transparency of PBM pricing, fees, and ownership interests
- Ban preferential reimbursement to PBM-owned pharmacies
- Mandate ongoing audits and data access for regulators and pharmacies
- Take emergency action to preserve pharmacy access during investigations
Closing Statement
Retail pharmacies are not asking for special treatment — only fair, transparent, and competitive markets.
PBMs have grown powerful enough to control prices, access, and survival itself. Without immediate FTC action, the damage may soon be irreversible.
We respectfully urge the Federal Trade Commission to act now.