A recent report from the House Committee on Oversight and Accountability reveals that pharmacy benefit managers (PBMs) are directing patients toward costlier medications while restricting their access to different pharmacies.
The investigation, which lasted 32 months and was previewed by the Wall Street Journal, precedes a hearing involving executives from the largest PBMs in the country, including Express Scripts, OptumRx, and Caremark, which collectively manage around 80% of U.S. prescriptions.
The report highlights that PBMs maintain lists of preferred drugs that favor higher-priced brand-name medications over their more affordable counterparts. Notably, it mentions communications from Cigna staff that discouraged the use of cheaper alternatives to Humira, an arthritis treatment previously costing $90,000 annually, despite the availability of a biosimilar priced at half that amount.
Furthermore, the committee discovered that Express Scripts informed patients they would incur higher costs if they opted to fill prescriptions at their local pharmacies as opposed to ordering a three-month supply from its affiliated mail-order service. This practice has limited patient choice regarding pharmacy selection.
This report follows a similar one released earlier this month by the U.S. Federal Trade Commission, which stated that increasing consolidation among PBMs has allowed the six largest entities to control nearly 95% of all prescriptions in the United States.
The findings raise concerns about the significant influence PBMs wield over Americans’ access to affordable medications. The FTC highlighted that these vertically integrated PBMs could potentially prioritize their affiliated businesses, leading to conflicts of interest that disadvantage independent pharmacies and drive up drug prices.
FTC Chair Lina M. Khan emphasized that the results indicate these intermediaries are overcharging patients for cancer medications, resulting in an additional revenue stream exceeding $1 billion.