Rep. James Comer (R-Ky.), chairman of the House Committee on Oversight and Government Reform, is stepping up Congress' investigations into pharmacy benefit manager practices by seeking information about PBMs' use of group purchasing organizations (GPOs) headquartered overseas.
In two near-identical letters, Comer notified the CEOs of OptumRx and Cigna that the committee is looking into whether both companies use their "foreign headquartered group purchasing organization ... to evade transparency and oversight in the United States." Cigna/Express Scripts operates Ascent Health Services, headquartered in Switzerland, and UnitedHealth's Optimized controls Emisar Pharma Services in Ireland.
Comer noted that GPOs "appear to be yet another example of the institutional intent at opacity and avoidance of oversight within your company ... the committee is concerned that your company's opaque business practices and relationships, including the creation of new corporate structures abroad, combined with unchecked integration, is hurting patients and costing taxpayers." Comer requested that the companies disclose a range of materials to the committee about how these subsidiaries operate. Read Comer's press release on the letters here.
The committee held a hearing in July 2024 in which members grilled the CEOs of the Big Three PBMs; GPOs played a role in that hearing as well, with Republicans and Democrats raising concern over the role of these subsidiary companies. Rep. Greg Casar (D-Texas) asked OptumRx CEO Patrick Conway, "If these GPOs are generating this much more in fees, where is the value to the American people? Why is it that annual premiums continue to go up? Why is it that thousands of drugs have seen price increases, while billions of dollars in new fees and profits are going to PBMs via their GPOs?"
