NW Kentucky News

House Committee on Oversight and Accountability Chairman James Comer (R-Ky.) has issued a report detailing how the three largest Pharmacy Benefit Managers (PBMs)—CVS Caremark, Express Scripts, and OptumRx—have monopolized the pharmaceutical marketplace. The report alleges that these PBMs employ anticompetitive pricing tactics that raise prescription drug prices, undermine community pharmacies, and harm patients across the United States. A hearing with PBM executives is scheduled for today at 10:00 am ET.

"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. These self-benefitting pricing tactics pushed by PBMs have done nothing but jeopardize patient care, undermine local pharmacies, and raise prescription drug prices," said Chairman Comer. "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. Americans deserve access to affordable, life-saving medications and the Committee will continue to work in a bipartisan fashion to shine a light on PBMs and restore competition in the pharmaceutical marketplace."

The report titled “The Role of Pharmacy Benefit Managers in Prescription Drug Markets” includes evidence showing how PBMs inflate prescription drug costs and interfere with patient care for financial gain. It concludes that Congress and states need to implement legislative reforms to increase transparency in the PBM market.

Key findings from the report include:

- The three largest PBMs use their position as middlemen integrated with health insurers, pharmacies, providers, and manufacturers to enact anticompetitive policies. They share patient information across their companies to steer patients toward pharmacies they own and reduce reimbursement rates for competing pharmacies.

- Despite claims of providing savings through negotiation and spread pricing, evidence indicates these schemes often increase costs for patients and payers. Instances were identified where federal government, states, and private payers found PBMs overcharging plans by hundreds of millions of dollars.

- Drug manufacturers are forced to pay rebates for favorable formulary placement by PBMs, making it difficult for lower-priced prescriptions like generics or biosimilars to be included. Higher-cost medications are often placed in more preferable positions even when cheaper options are available.

- In response to potential reforms, major PBMs have created foreign corporate entities in Switzerland and Ireland to centralize rebate negotiations while avoiding transparency requirements. They also established companies in Ireland and Cayman Islands for manufacturing profitable generics.

- Tools such as prior authorizations and formulary manipulations used by PBMs delay market uptake of cheaper generics/biosimilars and negatively impact patient care.

- Anticompetitive policies have cost taxpayers money while reducing patient choice. Taxpayer-funded health programs have been overcharged or had rebates withheld by PBMs who also steer patients towards owned pharmacies rather than potentially better or closer alternatives.

Supporting documents related to CVS Caremark, OptumRx, Express Scripts can be accessed via provided links.