Health Care Operations & Compliance, Professional Perspective – Exclusive Dealing & Drug Formularies: A Case Study on the Epipen Litigation, by Christopher Tellner, Esq., Abbye Alexander, Esq., Henry Norwood, Esq., published in Bloomberg Law, 8-2024

The interplay between pharmaceutical manufacturers, health insurers, and pharmacy benefit managers (PBMs) is rarely seen by consumers relying on the medications in their control. The market surrounding these actors is highly competitive and, at times, can be viewed as anti-competitive. Drug manufacturers use several methods to ensure their product is the only product of its kind available to members on an insurer’s drug formulary. These practices, referred to as exclusive dealing, play a major role in a consumer’s choice of medication and can result in large profits and losses to the manufacturers included or excluded from coverage. The ultimate price that consumers pay for medications and their ability to access needed medications can also be impacted by exclusive dealing. Exclusive dealing agreements between drug manufacturers and PBMs have come under antitrust scrutiny by courts in several jurisdictions.

In particular, several courts have considered the actions of those involved with the EpiPen. The courts’ view of exclusive dealing agreements impact drug manufacturers, PBMs, insurers, pharmacies, and consumers in their respective roles in the pharmaceutical chain of commerce.

PBMs & Prescription Drug Formularies

The EpiPen

Antitrust Law Prohibition on Exclusive Dealing

EpiPens Before the Courts

Read more at the full article.