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In an unexpected move, the Federal Trade Commission on Tuesday filed a lawsuit to block Amgen from acquiring Horizon Therapeutics, claiming the $27.8 billion deal would make it possible for Amgen to develop monopolies through a tactic that manipulates health coverage and drives up consumer costs.

At issue is a practice known as bundling. Simply put, a drug company combines two or more medicines in a package deal for health plans and pharmacy benefit managers, which determine lists of medicines that are covered by insurance. The practice has previously sparked concerns that a drug company will unfairly offer higher rebates for bundles in order to win favorable placement.

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Such accusations have come up before. Notably, Regeneron Pharmaceuticals last year filed a lawsuit accusing Amgen of using a bundling scheme to entice health plans to cover a cholesterol medicine. Regeneron alleged Amgen relied on rebates for several medicines to win favorable formulary placement, and that the move effectively crowded out its own cholesterol drug.

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