PBM Executives Accused of Lying During Recent Congressional Hearing
By Consumers for Quality Care, on September 18, 2024
In July, the top executives of the three largest pharmacy benefit managers (PBMs) – CVS Caremark, UnitedHealth Group’s Optum Rx, and Cigna’s express scripts – testified before the House Committee on Oversight and Accountability. Now, the committee’s chairperson, James Comer (R-KY), says that these executives perjured themselves during their appearance before the committee, Healthcare Dive reports. He’s even threatening the executives with fines or jail time for making statements that contradict the committee’s findings as well as research provided by the Federal Trade Commission (FTC).
PBMs are middlemen who set prices between prescription drug manufacturers, health plans, and pharmacies. PBMs claim to save consumers money, but they have been found to charge artificially high markups for drugs, boosting their own profits. Together, CVS Caremark, UnitedHealth Group’s Optum Rx, and Cigna’s Express Scripts control 80 percent of the PBM market.
During the hearing, PBM executives stated that consumers can fill prescriptions at the pharmacy of their choosing, including independent pharmacies, without additional fees. Yet the Committee found that Express Scripts, for example, sent messages to consumers saying that filling their prescriptions through the company’s mail-order pharmacy would be cheaper than going to their local pharmacy.
Moreover, the sheer size of these PBMs leaves independent pharmacies with little leverage to negotiate fair contracts with them, allowing PBMs to charge higher fees and forcing independent pharmacies to accept low reimbursement rates.
Lawmakers and regulators have increased scrutiny of the industry. PBM business practices have come under bipartisan fire in Congress, with both Republicans and Democrats launching investigations and calling for reforms, such as increased transparency. The recent House Oversight’s hearing was the first time PBM executives had testified in front of Congress since 2019. This summer, the FTC filed a lawsuit against the three largest PBMs over their price-negotiation tactics for critical prescription drugs, including insulin.
CQC urges lawmakers and regulators to continue to scrutinize harmful PBM practices that increase what consumers pay for prescription drugs.
