NW Kentucky News

Today, Congressman James Comer (R-Ky.) published an op-ed addressing the findings of his Oversight Committee investigation into the practices of the three largest Pharmacy Benefit Managers (PBMs)—CVS Caremark, Express Scripts, and OptumRx. According to Comer, these PBMs have monopolized the pharmaceutical marketplace through anticompetitive pricing tactics that are increasing prescription drug prices, undermining community pharmacies, and harming patients across the United States.

Comer states that during his travels across Kentucky’s 1st Congressional District, he frequently hears concerns about the high cost of prescription drugs. He notes that the cost of life-saving medications has increased every year for the past fifteen years. Americans now spend more on prescription drugs—about $1,200 per person—than any other country. In 2023 alone, patient out-of-pocket costs for prescriptions reached $91 billion.

"In 2021," Comer writes, "I began to use the power of the House Oversight Committee to examine the pharmaceutical marketplace and the middlemen of the drug supply chain: pharmacy benefit managers (PBMs)." Initially created to benefit the healthcare system with clear details about costs and rebates, PBMs have evolved into entities controlled by three major players—CVS Caremark, Express Scripts, and OptumRx—that collectively control 80 percent of the market.

Comer claims these PBMs now operate in secrecy and engage in practices that benefit themselves at patients' expense. "As Chairman of the House Oversight Committee," he says, "I recognized that Congress must act and made it a top priority to expose these anticompetitive tactics pushed by PBMs."

The investigation by Comer's committee has gathered over 140,000 pages of documents revealing several concerning practices. These include sharing patient information to steer patients toward PBM-owned pharmacies, reducing reimbursement rates for competing pharmacies artificially, overcharging plans through spread pricing schemes, and prioritizing higher-cost medications over equally effective lower-cost options.

Since 2023, Comer has led three Oversight Committee hearings examining these practices. He brought CEOs from CVS Caremark, Express Scripts, and OptumRx before Congress to address their actions directly. "I made it clear their Pharmacy Benefit Mafia is coming to an end," he asserts.

Comer is working with colleagues on bipartisan solutions aimed at increasing transparency and accountability within the PBM industry. He supports legislation such as the Pharmacists Fight Back Act to combat price gouging by PBMs and has helped pass—with broad bipartisan support—the Delinking Revenue from Unfair Gouging (DRUG) Act.

Additionally, Comer highlights recent actions by regulatory bodies: "In fact," he notes, "the Federal Trade Commission (FTC) just announced it is taking action against the three largest PBMs and suing their group purchasing organizations for engaging in anticompetitive tactics that are inflating the price of insulin drugs." This move by FTC follows from insights gained through Comer's committee's investigation.

Comer concludes his op-ed with a call for continued legislative efforts: "Kentuckians and Americans across the nation deserve access to affordable life-saving drugs... It’s time for PBMs to have a taste of their own medicine."

Rep. James Comer represents Kentucky’s 1st Congressional District and serves as Chairman of the House Committee on Oversight and Accountability.