House Oversight Panel
To Investigate PBMs’
Role in Driving Up
Health Care Costs
House Committee on Oversight and Accountability Chairman James Comer (R-KY) has launched an investigation into PBM tactics that are harming patient care and increasing patient costs. Comer has asked senior officials at the Office of Personnel Management, CMS and the Defense Health Agency for documents and communications that might illustrate the extent that PBMs’ tactics impact healthcare programs administered by the federal government.
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.
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.
"Greater transparency in the PBM industry is vital to determine the impact that their tactics are having on patients, the pharmaceutical market, and healthcare programs administered by the federal government," Comer wrote. "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."
Initial findings in Committee Republicans’ December 2021 report showed that large PBM consolidation has negatively impacted patient health, increased costs for consumers, forced manufacturers to raise their prices, and created conflicts of interest that distort the market and limit high-quality care for patients.
Below are the letters that Comer sent to the three PBMs: