Pharmacy benefit managers (PBMs) are being targeted yet again by the government. James Comer (R-Ky), House Committee on Oversight and Accountability chairman, launched an investigation Wednesday into PBMs and their “tactics that are harming patient care and increasing costs for consumers.”
Comer sent letters to the Office of Personnel Management, Centers for Medicare and Medicaid Services and the Defense Health Agency asking for documents that show how PBMs’ practices are affecting federal government healthcare programs. In addition, he sent letters to CVS Caremark, Express Scripts and OptumRx — which control 80% of the PBM marketplace — asking them to provide “documents, communications and information” on their tactics. This includes rebates or fees paid to them and incentives encouraging patients to use pharmacies owned by them.
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“Pharmacy Benefit Managers’ anticompetitive tactics are driving up health care costs for Americans and harming patient care,” Comer said in a news release. “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.”
The letters claim that PBMs use “self-benefiting practices,” including “fail first” policies that require patients to first fail on the PBM’s drug before they start using the drug first prescribed to them. Another practice the letters call out is prior authorization, which delays patient care, Comer said. In addition, he calls out spread pricing, a tactic in which PBMs charge payers more for a drug than what they paid the pharmacy and then keep the difference.
“The focus of the pharmaceutical marketplace should be on the patient. Greater transparency is needed to determine the impact PBM tactics are having on patients and the pharmaceutical market,” the letters state.
Comer added that action is needed to protect patients and make prescription drugs less costly.
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“Greater transparency in the PBM industry is vital to determine the impact that their tactics are having on patients, the pharmaceutical market, and health care programs administered by the federal government,” he said in a statement. “The House Oversight and Accountability Committee is shining a light on this issue in the healthcare system and will continue to examine solutions to make prescription drugs more affordable for all Americans.”
The news follows a Senate Commerce Committee hearing held in February that discussed how the Pharmacy Benefit Manager Transparency Act would impact drug prices. The bill, introduced by Sen. Maria Cantwell (D-Washington) and Sen. Chuck Grassley (R-Iowa), would ban PBMs from clawing back reimbursement payments and participating in spread pricing.
In June, the Federal Trade Commission also launched an investigation into six PBMs: Express Scripts, CVS Caremark, OptumRx, Humana, Prime Therapeutics and MedImpact Healthcare Systems.
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