Accountability Chairman James Comer Demands PBM Executives Correct Hearing Testimony

It was a rough summer for Pharmacy Benefit Managers (PBMs). In July, the House Committee on Oversight and Accountability Chairman James Comer (R-KY) issued a report detailing how the 3 largest PBMs (CVS Caremark, Express Scripts, and OptumRx) had monopolized the pharmaceutical marketplace by deploying anticompetitive pricing strategies. The report was based on an examination of over 140 000 documents and communications from the 3 major PBMs, which revealed how PBMs inflate medication prices and interfere with patient care. The report was immediately followed by a hearing with PBM executives titled “The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part III: Transparency and Accountability.” At the hearing, PBM executives were pushed, unsuccessfully, to explain their roles in rising drug costs in the country.

Highlights from the Committee’s findings include:

• PBMs are pushing pricing tactics designed to benefit themselves, including inflating prescription drug costs and interfering with patient care for financial gain by prioritizing costs over doctors’ recommendations and using tools such as prior authorizations and formulary manipulation.
• PBMs undermine local pharmacies by steering patients to pharmacies affiliated with PBMs.
• The 3 largest PBMs control 80% of the health market and have colluded to keep prices high and limit patient choice.
• Executives of the 3 major PBMs refused to provide clear answers at the hearing.

The Committee concluded that Congress has a responsibility to act to protect Americans. The bipartisan Oversight Committee will work to advance legislative solutions.

At the end of August, Committee Chairman Comer called on the CEOs of CVS Caremark, Express Scripts, and OptumRx to correct the official record of the hearing testimony. According to Comer, the PBM executives’ statements conflicted with the Oversight Committee and Federal Trade Commission findings about the PBMs’ bad practices. The executives testified that they did not steer patients to PBM-owned pharmacies and made contradictory claims to the FTC and Committee findings on contract negotiations, contract opt outs, and payments to pharmacies. In a letter, Comer reminded the executives that making false statements at a hearing under oath is perjury and could result in 5 years of prison time.

What’s Next?

Committee Chairman Comer has given David Joyner (President of CVS Caremark), Adam Kautzner (President of Express Scripts), and Patrick Conway (Chief Executive Officer of OptumRx) until September 11, 2024 to correct the record of their statements or be subject to potential penalties.