07:06 AM EDT, 07/10/2024 (MT Newswires) -- (Updates to add comment from United Health's Optum in the seventh paragraph.)

CVS Health's ( CVS ) Caremark, UnitedHealth Group's ( UNH ) Optum, and Cigna Group's ( CI ) Express Scripts are among the top six pharmacy middlemen that contribute to higher drug costs and challenge the viability of independent pharmacies, the US Federal Trade Commission said Tuesday in an interim report on pharmacy benefit managers.

Pharmacy benefit managers act as intermediaries in the pharmaceutical supply chain, negotiating drug prices and access for hundreds of millions of Americans with the top three PBMs -- Caremark, Optum, and Express Scripts -- managing 79% of prescription drug claims for 270 million people, the FTC said in its 71-page report.

The combined revenue of UnitedHealth ( UNH ), CVS Health ( CVS ), Cigna Group ( CI ), and Humana totaled $456 billion in 2016 and equaled 14% of US health expenditures, the report said. "Today, their combined revenue exceeds $1 trillion and equals 22% of national health expenditures."

PBMs have expanded into health insurers, healthcare providers, and drug private labeling, further increasing their influence and control over the healthcare market, the report said.

FTC Commissioner Melissa Holyoak issued a dissenting statement and said the report "leaves us without a better understanding of the competition concerns surrounding PBMs or how consumers are impacted by PBM practices."

"Our efforts have resulted in members on average paying less than $8 per 30-day supply of medication," CVS Caremark said in an email to MT Newswires. Any FTC policies limiting PBM negotiation tools would favor pharmaceutical companies and harm consumers, the company added.

"PBMs, like Optum Rx, are the key counterweight to pharmaceutical companies' monopoly power to set and raise drug prices," Optum Rx said in response to a request for comment from MT Newswires. "The FTC has rushed to publish an incomplete report with flawed conclusions that do not follow from the data and information Optum Rx provided to the agency," Optum added.

Cigna ( CI ) and Humana didn't immediately respond to requests for comment from MT Newswires.