October 29, 2024

Warren Urges FTC to Protect Cancer Patients, Closely Scrutinize Acquisitions of Oncology Practices for Anticompetitive Effects

“[B]y allowing wholesalers to assume control over the few remaining community oncology practices, … these deals could stifle competition and lead to even higher costs for patients.”

Proposed deals could threaten the price of lifesaving cancer drugs.

Text of Letter (PDF)

Washington, D.C. – Today, U.S. Senator Elizabeth Warren (D-Mass.) wrote to Chair Lina Khan of the Federal Trade Commission (FTC) urging the FTC to closely scrutinize two proposed deals in the oncology market and block them if they violate antitrust law. The deals include McKesson Corporation’s (McKesson’s) $2.49 billion proposed acquisition of a controlling stake in Core Ventures and Cardinal Health’s (Cardinal’s) $1.1 billion proposed acquisition of a controlling stake in Integrated Oncology, two management services organizations (MSOs) that oversee 150 oncology practices spanning 11 states. 

Three companies – Cardinal, McKesson, and Cencora – control over 90 percent of the drug wholesale market. Wholesalers were originally founded to distribute drug products from pharmaceutical manufacturers to places like hospitals, pharmacies, and doctors’ practices. But over the years, major wholesalers – including Cardinal and McKesson – have leveraged their market power to lock existing customers into restrictive contracts, block out competing wholesalers, and squeeze generic drug manufacturers, leading to more frequent drug shortages and higher drug costs.

In the letter, Senator Warren points out that the deals proposed by Cardinal and McKesson would further consolidate the market for oncology care, which is already “the most vertically integrated specialty” in the nation. As industries become more consolidated, there is less competition in the market, often driving up prices.

“I am concerned that, by allowing wholesalers to assume control over the few remaining community oncology practices, which have historically provided an affordable alternative to hospital-based cancer care, these deals could stifle competition and lead to even higher costs for patients,” wrote Senator Warren.

The scheme these wholesalers are running is simple: since they cannot legally own oncology practices outright in most states, they are buying up entities that oversee oncology practices. While these arrangements allow wholesalers to appear to be in compliance with existing law, they still leave wholesalers with the power to force oncology practices in their control to use their vertically-integrated wholesale services and disadvantage competitors, raising prices for patients.

“By controlling oncology practices, Cardinal and McKesson can require affiliated practices to enter into sole-source or prime vendor agreements with their wholesale businesses, ‘lock[ing] them in as customers’ and effectively blocking competing wholesalers from offering their services,” Senator Warren continued. 

Common ownership of wholesalers and oncology practices also introduces incentives to employ tactics that will drive greater profits to the parent company – such as increasing drug dosages, drug prices, and the number of patients doctors see at affiliated oncology practices – even if they are not in the best interest of patients or providers.

“These deals threaten to limit competition by opening the door for Cardinal and McKesson to expand their control of the already highly-concentrated oncology market by restricting affiliated oncology practices from contracting with rival drug wholesalers,” wrote Senator Warren. “Accordingly, I urge the Federal Trade Commission … to closely scrutinize these proposed deals and block them if they violate antitrust law.”

This letter follows outside pressure from organizations like the American Economic Liberties Project, who have raised similar concerns to the FTC.


Senator Warren has led efforts to use every tool available to the government to lower drug prices and fight anticompetitive business practices in the health care industry:

  • In October 2024, Senator Elizabeth Warren (D-Mass.) urged the FTC to closely scrutinize the Novo Nordisk-Catalent merger and to block it if it violated antitrust law.

  • In September 2024, Senator Elizabeth Warren (D-Mass.) and Representative Lloyd Doggett (D-Texas) wrote to Department of Health and Human Services (HHS) Secretary Xavier Becerra asking him to lower the cost of vital weight-loss drugs by using the agency’s existing legal authority to issue generic licenses for semaglutide, a prescription drug sold under the names Ozempic and Wegovy.

  • In August 2024, Senators Warren and King and Representative Doggett wrote to Department of Health and Human Services Secretary Xavier Becerra and Department of Commerce Secretary Gina Raimondo reiterating their agencies’ clear legal authority to use “march-in” rights under the Bayh-Dole Act to lower drug prices for Americans.

  • In June 2024, Senator Warren and Representative Pramila Jayapal (D-Wash.) sent letters to eight pharmaceutical companies urging them to voluntarily de-list over 100 patents that the Federal Trade Commission (FTC) has determined may be improperly or inaccurately listed in the Food and Drug Administration’s (FDA’s) Orange Book, which would open opportunity for more competition and lower drug prices for Americans.

  • In May 2024, Senator Warren and Representative Lloyd Doggett (D-Texas) sent a letter to Secretary of the Department of Commerce, Gina Raimondo, and Under Secretary Laurie Locascio, highlighting the lawmakers’ new review of public comments on the agency’s Draft Interagency Guidance Framework for Considering the Exercise of March-In Rights and urged them to strengthen and finalize the guidance. 

  • In May 2024, Senators Warren,  Bernie Sanders (I-Vt.), and Jeff Merkley (D-Ore.) wrote to the Chamber of Commerce expressing concern and demanding an explanation for the organization’s opposition to the Biden administration’s proposal to boost competition and lower drug prices for American families and businesses by allowing agencies to consider price when deciding to exercise their “march-in rights” under the Bayh-Dole Act. 

  • In April 2024, Senator Elizabeth Warren (D-Mass.) sent a letter to the leadership of Novo Nordisk (Novo), slamming the company for its decision to discontinue production of Levemir (detemir) insulin, one of only three long-acting insulins on the market, and asked the company to commit to continue producing Levemir until a biosimilar is made available.

  • In March 2024, Senator Warren sent a letter in response to GlaxoSmithKline (GSK) discontinuing the brand-name version of Flovent HFA, the go-to inhaler for children, blasting the company for its price-gouging strategy that may cause millions of children to lose access to one of the few drugs that is appropriate to treat their asthma and allergies. 

  • In February 2024, Senators Warren and Angus King (I-Maine) and U.S. Representative Lloyd Doggett (D-Texas) led 75 lawmakers in sending a letter to the Biden administration in support of strengthening and finalizing its draft guidance to protect taxpayers and reduce prescription drug prices. The lawmakers submitted a public comment supporting the “Interagency Guidance Framework for Considering the Exercise of March-In Rights” and calling for changes to ensure increased transparency, oversight, and accessibility of medical products invented through taxpayer-funded research and development.

  • In February 2024, Senator Warren and Representative Jayapal announced that three drug manufacturers pulled their sham patents after warnings, and urged the FDA to continue fighting against Big Pharma’s patent abuse. 

  • In December 2023, Senator Warren published an op-ed in Newsweek commending the Biden administration’s announcement that price can be considered in the government’s decision to march-in on a drug, effectively lowering drug costs, and calling on Americans to fight back against an industry that has been taking advantage of them for decades. 

  • In December 2023, Senator Warren issued a statement after the Biden administration announced it would issue guidance to federal agencies that would allow the government to seize patents of certain expensive drugs developed with taxpayer support to create more competition and lower prices.

  • In December 2023, Senator Warren and Representative Jayapal sent letters to the CEOs of 8 pharmaceutical companies urging them to voluntarily remove sham patent claims improperly included in the FDA’s Orange Book and end their unlawful practices that delay competition and drive up costs for patients and taxpayers.

  • In December 2023, Senator Warren and Representative Jan Schakowsky (D-Ill.) reintroduced the  Affordable Drug Manufacturing Act, legislation that would radically reduce drug prices through public manufacturing of prescription drugs. 

  • In September 2023, Senator Warren and Representative Jayapal sent a letter to FTC Chair Lina Khan urging the FTC to issue a policy statement about the improper listing of drug-related patents in the FDA’s Orange Book. 

  • In August 2023, Senator Warren and Representative Jayapal sent a letter to FDA Commissioner Dr. Robert M. Califf, urging him to close loopholes that pharmaceutical companies have exploited to block generics from entering the market, keeping drug prices high and maximizing profits. 

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