U.S. Food and Drug Administration chief Scott Gottlieb on Wednesday criticized drugmakers, pharmacy benefit managers and health insurers for "Kabuki drug-pricing constructs" that expose consumers to high costs and that discourage competition.

"Patients shouldn't face exorbitant out-of-pocket costs, and pay money where the primary purpose is to help subsidize rebates paid to a long list of supply chain intermediaries," Gottlieb said at an annual conference of health insurers. "Sick people aren't supposed to be subsidizing the healthy."

He criticized the health industry for failing to promote access to so-called biosimilar versions of drugs, and for pricing practices that harm consumers.

Biosimilars are copies of original drugs that are supposed to be as effective but cheaper. Kabuki is a form of Japanese theater characterized by dramatization and elaborate costumes.

Gottlieb said practices in the healthcare industry "obscure profit taking across the supply chain that drives up costs" and discourage competition.

He noted that the top three pharmacy benefit managers - CVS, UnitedHealth Group Inc. and Express Scripts - control more than two-thirds of their market. The top three wholesalers - AmerisourceBergen Corp, Cardinal Health Inc and McKesson Corp - control more than 80 percent; and the top five pharmacies more than 50 percent, he said.

America's Health Insurance Plans, a health insurer lobbying group also hosting the conference, said drug manufacturers were to blame for the high cost of prescription medicines.