NW Kentucky News

WASHINGTON—Today, the House Committee on Oversight and Accountability held a hearing titled “The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part III: Transparency and Accountability.” At the hearing, Republicans and Democrats questioned Pharmacy Benefit Manager (PBM) chief executives about their role in rising prescription drug costs. Lawmakers revealed how PBMs have collaborated to monopolize the pharmaceutical marketplace, pushing anticompetitive policies that undermine local pharmacies, raise the cost of lifesaving drugs, and harm patients across the country. Earlier today, Chairman James Comer (R-Ky.) issued a staff report detailing the self-benefiting pricing tactics used by the PBM industry. Lawmakers concluded Congress must continue working in a bipartisan manner to address harmful PBM practices and advance legislative solutions to protect patients and reduce drug costs.

Key Takeaways:

The House Oversight Committee’s investigation reveals that Pharmacy Benefit Managers play an oversized role in the pharmaceutical supply chain and push deliberate pricing tactics for their own financial benefit.

The Oversight Committee obtained over 140,000 documents and communications from CVS Caremark, Express Scripts, and OptumRx—the three largest PBMs controlling 80 percent of the health market. These documents form the basis of a new report titled “The Role of Pharmacy Benefit Managers in Prescription Drug Markets,” showing how PBMs inflate prescription drug costs and interfere with patient care for their own financial gain.

Chairman James Comer stated: “Since 2021, the Committee has made it a priority to expose harmful PBM practices and advance legislative solutions to ensure greater transparency and accountability in the PBM industry. Instead of prioritizing the health of Americans across the country, evidence obtained by the House Oversight Committee shows how the three largest pharmacy benefit managers colluded to line their own pockets.”

Executives from CVS Caremark, Express Scripts, and OptumRx refused to provide clear answers to lawmakers during questioning.

During the hearing, PBM executives declined to answer questions related to retroactive DIR fees impacting independent pharmacies or why there are 600 different prices set for a single drug across the country. They also did not clarify how PBMs steer patients to pharmacies they own.

Congress has committed to act on this issue. The Oversight Committee will continue working in a bipartisan fashion to advance legislative solutions combating harmful PBM industry tactics.

Earlier this year, H.R. 6283 was passed by the Oversight Committee. Known as the Delinking Revenue from Unfair Gouging (DRUG) Act, it creates certain requirements for PBMs contracting with carriers offering health benefits plans under FEHB program.

Member Highlights:

Chairman Comer discussed how PBMs blame drug manufacturers for higher medication costs despite reports showing that PBMs charge different prices across regions.

Chairman Comer highlighted a case where CVS Caremark was ordered by a federal court to pay over $20 million due to miscalculated DIR fees: “Given these findings, do you intend to pay all practices back for this miscalculation or fight them like you did with New York?”

Mr. Joyner from CVS Health responded: “We comply with all Medicare Part D rules… our goal is consistency across all 65,000 pharmacies.”

Rep. Gary Palmer examined why prescription drug costs have risen annually for fifteen years despite claims that PBMs reduce medication costs: “How can you convince Americans that you’re helping reduce costs when they’ve gone up so much?”

Dr. Kautzner of Express Scripts noted: “In 2023... patients spent less out-of-pocket on average for thirty-day prescriptions than they did in 2022.”

Rep. Virginia Foxx discussed price transparency issues with Mr. Joyner who claimed: “We pass over ninety-nine percent of rebates and administrative fees across our book of business…”

Rep. Ro Khanna criticized PBMs for prioritizing cost over doctors’ recommendations: “Why can’t you commit to following doctors’ recommendations?”

Dr. Conway responded: “It is critically important to follow evidence.”

Rep. Pat Fallon cited an FTC report revealing how PBMs undermine local pharmacies by steering patients toward affiliated ones.

Rep. Andy Biggs expressed concerns about limiting options for service members insured through TRICARE due to recent network changes involving pharmacy removals.

Rep. Lisa McClain demanded data proving that PBMs benefit patients rather than providing just PowerPoint presentations.

Rep. Buddy Carter shared his personal experience as a pharmacist seeing patients struggle due to limited options imposed by major PBMs: "Whether Republican or Democrat... we want affordable healthcare."

Further information can be found through statements from Chairman Comer on holding Pharmacy Benefit Managers accountable for rising drug prices.

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