PBMs will face House committee grilling next week

The House Committee on Oversight and Accountability will quiz leaders of pharmacy benefit managers (PBMs) at a hearing next week, amid scrutiny of the sector's role in rising healthcare costs in the US.

The hearing – scheduled for 23rd July – is part of an ongoing investigation by the committee into PBMs' alleged anticompetitive practices launched last year and spearheaded by chairman James Comer (R-Ky).

It comes right on the heels of a Federal Trade Commission (FTC) report that concluded that the market dominance of the top companies has "dire consequences," increasing prescription drug costs, hurting independent pharmacies, and compromising patient care. The regulator has also accused the PBMs of failing to cooperate wholly with its investigation, which has been running since 2022.

Last week, there were reports that the FTC was planning legal action against the top three PBMs – UnitedHealth's OptumRx, CVS Health's CVS Caremark, and Cigna's Express Scripts – claiming they skewed the market by pushing patients to use more expensive drugs, including branded versions of insulin.

Comer said that senior executives of those three PBMs – which control around 80% of the market – will testify at the hearing. Scheduled to appear are CVS Caremark president David Joyner, Express Scripts president Adam Kautzner, and OptimRx chief executive Patrick Conway.

"Both Republicans and Democrats on the House Oversight Committee have sounded the alarm over anticompetitive tactics deployed by [PBMs] and their role in rising drug prices," he said in a statement. The committee has seen evidence that the companies have used spread pricing - the difference between the amount a PBM reimburses a pharmacy for a prescription and the amount it charges a health plan sponsor – as well as rebates to monopolise the pharma market.

"It's clear these self-benefitting practices only serve to help their bottom line rather than patients," continued Comer. "PBMs have been allowed to hide in the shadows for far too long."

The PBM sector, represented by the Pharmaceutical Care Management Association (PCMA), claims that the FTC report "completely overlooks the volumes of data that demonstrate the value that PBMs provide to America's health care system by reducing prescription drug costs and increasing access to medications."

Earlier this year, the House Oversight Committee passed the Delinking Revenue from Unfair Gouging (DRUG) Act (HR 6283), which Comer said would reign in abusive practices by some PBMs that offer plans under federal employee health benefits programmes. That includes prohibitions on spread pricing and patient steering.