Scrutiny intensifies for PBMs as CEOs face threats
The three largest PBMs, including CVS Caremark, Express Scripts and OptumRx, “handle 79% of U.S. medical prescriptions for approximately 270 million people.”
The CEOs of three major Pharmacy Benefits Managers (PMBs) including CVS Caremark, Express Scripts and OptumRx may be facing fines or imprisonment of up to five years, according to a House Committee on Oversight and Accountability press release that was shared last week.
James Comer, chairman of the House Committee on Oversight and Accountability is calling on executives to correct the record for statements made during a hearing titled, “The Role of Pharmacy Benefits Managers in Prescription Drug Markets Part III: Transparency and Accountability.”
“At our hearing, the witnesses claimed they do not steer patients to PBM-owned pharmacies,” the committee wrote on X. “The executives also made claims contradicting the committee’s and FTC’s findings regarding contract negotiations, contract opt outs, and payments to pharmacies.”
According to a Becker’s Hospital Review article, the chairman’s letter comes at a time when scrutiny of PBMs is high in Washington D.C., with the FTC recently accusing the industry of, “favoritism toward its own pharmacies and creating vast market control, affecting both medication access and affordability.”
David Joyner, president of CVS Caremark; Adam Kautzner, PharmD, president of Cigna’s Express Scripts; and Patrick Conway, MD, CEO of UnitedHealth’s OptumRx must provide any necessary corrections to the record by Sept. 11th. Although, all three have claimed on the record that they do not steer patients to PBM-owned pharmacies and have made statements contradictory to committee findings concerning contract negotiations, contract opt outs and payments to pharmacies.
Related: FTC staff objects to big PBMs’ ‘outsized influence’ in interim report
According to Becker’s Hospital Review, the three largest PBMs, including CVS Caremark, Express Scripts and OptumRx, “handle 79% of U.S. medical prescriptions for approximately 270 million people.” And further incorporation with health insurers would allow for even more control over medication and prices and access, said the FTC.
During second quarter calls with investors, however, the CEOs of CVS and Cigna said their PBMs save customers money and promised to defend their businesses in Washington.