- The House Oversight and Accountability Committee is launching an investigation into pharmacy benefit managers over alleged anti-competitive tactics, according to a release from Chairman James Comer, R-Ky.
- It’s the latest action targeting PBMs for allegedly using their market power to raise drug prices amid rising scrutiny, and comes as the Federal Trade Commission also launched a similar investigation.
- Comer requested documentation regarding PBMs’ practices to determine how they are impacting healthcare programs administered by the federal government from the Office of Personnel Management, the CMS and the Defense Health Agency, according to a release.
PBMs — which negotiate rebates with manufacturers on behalf of a health insurance plan, serving as middlemen between drugmakers, health plans and pharmacies — have garnered attention recently for their role in rising prescription drug prices.
In January, California sued a number of major drugmakers and PBMs for allegedly overcharging patients for insulin, claiming the manufacturers artificially increased list prices and PBMs received a larger percentage of the drug list price, known as a rebate.
Concerns over PBM practices led the FTC to launch an investigation last year, with the agency requiring the the six largest PBMs in the country — CVS Caremark, Express Scripts, OptumRx, Humana, Prime Therapeutics and MedImpact Healthcare Systems — to turn over detailed information on their business practices.
Shortly after, the FTC voted unanimously to adopt a policy statement to more closely analyze fees and rebates paid to PBMs in exchange for coverage for their drugs from payers.
While the FTC has yet to complete its PBM investigation, the House committee is now requesting information from agencies and PBMs related to the role the middlemen play in government healthcare programs.
“Federal agencies administering health care programs for seniors, active-duty military, and federal employees rely on PBMs as middlemen to set drug prices, which opens the door to government waste at the expense of American taxpayers,” Comer said in the release.
Three PBMs control an estimated 80% of the marketplace: CVS Caremark, Cigna’s Express Scripts and UnitedHealth Group’s OptumRx, according to the release.
Committee members previously analyzed PBMs in a December 2021 report, and found that PBM consolidation has raised costs for consumers, made manufacturers raise their prices and ultimately negatively impacted patient health.
Comer sent letters to the OMB, the CMS, the DHA, CVS Caremark, Express Scripts and OptumRX as part of the investigation.