Mercalis (formerly TrialCard) Responds to FTC on Harmful Impact of Pharmacy Benefit Manager (PBM) Practices on Consumers

On June 7, 2022, the Federal Trade Commission (FTC) announced that it would conduct an inquiry into some of the business practices of pharmacy benefit managers (PBMs) impacting affordability of prescription drugs and ordered the six largest PBMs to provide information and records to the Commission.

This inquiry came after multiple complaints about PBM practices from both patients and healthcare professionals. Lina M. Khan, FTC Chair, said: “Although many people have never heard of pharmacy benefit managers, these powerful middlemen have enormous influence over the U.S. prescription drug system. This study will shine a light on these companies’ practices and their impact on pharmacies, payers, doctors, and patients.”

Mercalis (formerly TrialCard) has provided comments to the FTC in an attempt to help the Commission focus on PBMs’ accumulator practices as one of these potentially inappropriate practices.

Accumulator adjustment programs prevent any co-payment assistance that may be available for high-cost specialty drugs from counting toward a patient’s deductible, or maximum out-of-pocket expenses. Patients with a high deductible may pay a high out-of-pocket cost before this is met. Therefore, if using a copay savings program does not count toward a patient’s deductible, the patient could potentially pay significantly more out of pocket in a calendar year as it will take more time to meet their deductible.

The use of accumulator programs has become widespread, affecting millions of consumers, and yet many consumers are unaware of the practice, which is either undisclosed or only inadequately discussed in any customer-facing materials.

As a result, Mercalis (formerly TrialCard) has tried to help focus the FTC’s attention on these practices as part of their investigation into PBMs.