It’s been a lousy three weeks for the PBMs. First, a series of blistering articles from the New York Times, the Wall Street Journal, and others exposed their mafia-style business practices in shocking detail. Then the FTC issued its blistering preliminary report from a years-long study that screams for reforms and possibly litigation. Yesterday, executives for Caremark, Express Scripts, and Optum sweated through hours of questions from angry lawmakers in both parties who agree on little else, except that the PBMs are bad-faith actors taking advantage of patients, taxpayers, and local pharmacies.
Chairman James Comer (R-Ky.) and nearly every other member of the committee hammered the execs on charging patients more, anticompetitive opt-out contracts for pharmacies, patient steering, requiring prior authorization for patients, and formulary cherry-picking. At one point, Comer stopped the hearing to remind the witnesses they were under oath. Ouch. Additionally, Reps. Buddy Carter (R-Ga.), Mariannette Miller-Meeks (R-Iowa), Diana Harshbarger (R-Tenn.), Celeste Maloy (R-Utah), and Jake Auchincloss (D-Mass.) requested to join the hearing and get their licks in too. NCPA was grateful to have worked with the committee as they compiled the report, and as the members prepared for this third hearing.
NCPA CEO Douglas Hoey summed up the hearing this way: “Patient steering, self-dealing formularies, spread pricing, take-it-or-leave-it contracts, the fee-for-nothing scam … legislators have seen enough that the PBM-insurers can no longer obfuscate these important issues. We applaud the committee for its work and encourage its members and the rest of their colleagues in Congress to finish the fight. Finalize PBM reform now and rein in these and other harmful PBM tactics.” You can see the full press release here.
It was quite a show, and before the curtain even went up, the committee released its own report blowing up the PBMs and calling for federal and state reforms. After more than a year of research and more than 140,000 pages of documentation from the three largest PBMs, the committee found that CVS Caremark, Express Scripts, and OptumRx have monopolized the market through deliberate, anticompetitive practices which have increased the cost of prescription drugs and put community pharmacies and patients at risk for their own financial advantage. The committee found evidence that PBMs share patient information and data across their many integrated companies for the specific and anticompetitive purpose of steering patients to pharmacies a PBM owns. Furthermore, the committee found that PBMs have sought to use their position to artificially reduce reimbursement rates for competing pharmacies. Check out the full report here.
In case you missed it, the hearing was recorded. Here it is. In the meantime, we’re going out on a limb and guessing that you had a much better Tuesday than the PBM execs.
