Patients Before Monopolies Act

Summary#

This bill would make it illegal for a single person or company to both own or run a pharmacy and own or run an insurance company or a pharmacy benefit manager (PBM). Companies that violate the rule must sell their pharmacies within one year. The Federal Trade Commission (FTC) and the Justice Department (Antitrust Division) would enforce the law. They must issue guidance within 30 days and can require milestones for divestiture. If a company misses milestones, 10 percent of its profits would be put into escrow each month until divestiture. If divestiture still does not occur by the deadline, a trustee can sell the pharmacy.

The bill allows civil lawsuits by the HHS Inspector General, the FTC, the Justice Department, or a state attorney general. Individuals who claim they were harmed can sue and, if they win, may recover treble damages, attorney fees, and other relief. Courts can order companies to stop the violation, force divestiture, and require disgorgement of revenue earned from pharmacy sales during the violation. Disgorged funds would go into an FTC-created fund to serve harmed communities. The FTC must make rules to implement the law and report quarterly to Congress. The bill also defines "pharmacy" and "pharmacy benefit manager" and explains how divestitures will be reviewed.

What it means for you#

• If you work for or own a pharmacy that is owned by an insurer or PBM, that pharmacy may need to be sold within one year.
• If you are an individual who believes you were harmed by a covered ownership practice, you can bring a civil lawsuit for damages.
• State attorneys general, the FTC, and the Justice Department can sue to enforce the law and seek orders to stop ownership and force sales.
• The bill directs federal agencies to review and approve divestitures and to create rules and reports about compliance.
• No publicly available information on how this bill would change drug prices or insurance coverage.

Expenses#

• No publicly available information on federal budgetary costs or savings from this bill.
• The bill does specify enforcement actions and penalties: monthly escrow transfers equal to 10 percent of a company's profits for missed milestones, possible disgorgement of pharmacy revenues, and treble damages and attorney fees for successful private lawsuits.

Proponents' View#

The bill's findings state that PBMs now play a large role in the drug supply chain and that the market is highly concentrated. It says many PBMs are part of large health conglomerates that also own pharmacies or insurers. The bill says these vertical ties let PBMs steer business to affiliated pharmacies, reduce competition, pressure independent pharmacies into unfavorable contracts, and may have contributed to pharmacy closures. Proponents argue structural separation is needed to remove conflicts of interest, protect patients and independent pharmacies, and restore competition. The bill also says the FTC and Justice Department should get authority to review and block transactions that recreate these conflicts.

Opponents' View#

No publicly available information.