FTC adds a 3rd GPO to its investigation into pharmacy benefit managers

The Federal Trade Commission is building out its deep dive into the pharmacy benefit management industry yet again.

The agency said Thursday that it has sent an order to the group purchasing organization Emisar Pharma Services, requiring it to provide information and records pertaining to its business practices. The order follows similar missives sent to two other GPOs, Zinc Health Services and Ascent Health Services, last month.

Emisar negotiates rebates with drugmakers on behalf of Optum Rx, a UnitedHealth Group subsidiary and one of the three largest PBMs.

The FTC said its order to Emisar is "substantially similar" to those issued to Zinc and Ascent.

Zinc operates as the GPO for CVS Health's Caremark, while Ascent provides such services to Express Scripts, Prime Therapeutics, Humana Pharmacy Solutions and Envolve Pharmacy Solutions. Caremark, Express Scripts and Optum dominate the PBM market, collectively holding 80% of market share in the industry.

PBMs have been on the hot seat in recent weeks, with multiple pushes for reform making their way through Congress. The FTC sent orders to six of the largest pharmacy benefit managers in the U.S. a year ago, seeking greater detail into their business practices.

The letters went to Caremark, Express Scripts, Optum, Humana, Prime Therapeutics and MedImpact Healthcare Systems, ordering the companies to submit records on their business practices.

A central concern in the conversation around PBMs is the rise of vertical integration in the insurance market. Caremark is a sister company to Aetna under CVS Health, and Express Scripts is a subsidiary of Cigna. UnitedHealth Group also owns UnitedHealthcare, the country's largest commercial insurer.

Humana is a major player in the Medicare Advantage space nationwide, and Prime Therapeutics is collectively owned by a slew of Blue Cross Blue Shield plans.

Group purchasing organizations are also often sister companies to PBMs, which has similarly drawn ire from legislators.

Interest in reforms to the pharmacy benefit management market has grown alongside rising drug prices. Pharmaceutical companies have pointed the finger at PBMs as the culprit in price increases, and the lack of transparency in the industry lends credence to those claims to many policymakers.