FTC findings on rebates frame access fight for newer heart drugs

Federal Trade Commission findings on pharmacy benefit managers are being cited in debates over how newer ATTR-CM drugs win insurance coverage.

The FTC's interim staff report found that PBMs and drugmakers enter deals that can limit access to lower-cost drugs in exchange for rebates. The six largest PBMs manage nearly 95% of US prescriptions, and rebate-aggregation fees reached $7.6 billion in 2022, Managed Healthcare Executive reported. The PBM industry called the report one-sided.

In ATTR-CM, Pfizer has held coverage and contracting relationships for tafamidis since its 2019 approval. BridgeBio's Attruby, approved in 2024, entered at a list price of about $244,000 a year, below tafamidis's roughly $268,000.

An IBTimes article on the drug-pricing machine described how rebate structures can favor heavily rebated products over cheaper rivals. Critics argue that formulary preferences in ATTR-CM should be justified by evidence and net cost rather than by an incumbent's negotiating position.