Sen. Chuck Grassley is urging the Federal Trade Commission to "find consensus" and vote again to launch a study into the business practices of pharmacy benefit managers, according to a letter he sent to FTC Chairwoman Lina Khan dated March 9.
"PBMs operate with little to no transparency, making it very difficult if not impossible to understand the flow of money in the prescription drug marketplace," the Republican senator from Iowa said in his letter, nodding to the bipartisan consensus for such an examination.
Grassley urged the commissioners to come up with a more targeted focus for the study and suggested narrowing a review to the impact on consumers and their out of pocket costs.
The senator's comments follow the FTC's February vote in which commissioners were deadlocked, 2-2, and the effort to launch an inquiry failed. A study would have compelled large PBMs to turn over information and documents to the agency.
The two commissioners who voted against the study, Noah Phillips and Christine Wilson, were both appointed by former President Donald Trump. At the time, they didn't seem opposed to studying the issue, but they were concerned about whether the study as drafted asked the right questions.
Phillips also complained that he received a "substantially revised" draft from FTC staff "just hours" before the vote, according to Healthcare Dive's previous reporting.
Preceding the vote, commissioners heard from independent pharmacists from across the country who urged them to use the agency's power to launch a formal inquiry into PBMs, which serve as the middlemen between drug manufacturers, health plans and pharmacies.
Pharmacists warned commissioners that they are being squeezed out of the market by the practices of PBMs. Many independent pharmacists complained of the fees PBMs can claw back days or even months after a prescription is filled, which can cause them to lose money on certain prescriptions.
Many of the nation's largest insurers own a PBM, which are essentially gatekeepers for prescription drugs in the U.S. PBMs dictate which drugs are covered each year.
Shortly after commissioners failed to secure enough votes needed to launch a study, the FTC said it was sending out a request for information and wanted to hear from the public about how PBMs affect patients, pharmacies and employers.