A recent report from the House Committee on Oversight and Accountability reveals that pharmacy-benefit managers (PBMs) are directing patients towards more expensive medications while restricting their options for pharmacies. The findings, which emerge from a 32-month investigation, lead into an upcoming hearing featuring executives from the largest PBMs in the country.
PBMs act as third-party administrators for prescription drug plans and negotiate prices with pharmaceutical companies, influencing the out-of-pocket expenses for patients. The three largest PBMs in the U.S. — Express Scripts, UnitedHealth Group’s OptumRx, and CVS Health’s Caremark — control around 80% of the nation’s prescriptions.
The committee’s report identifies that these PBMs have established preferred drug lists that favor higher-priced branded drugs over less expensive alternatives. An instance mentioned involves Cigna discouraging the use of more affordable options to Humira, an arthritis medication costing around $90,000 annually, despite the availability of biosimilars priced at half that amount.
Moreover, Express Scripts purportedly informed patients that they would incur higher costs by filling their prescriptions at local pharmacies compared to obtaining a three-month supply from its affiliated mail-order service, thus limiting patient pharmacy choices.
Earlier this month, the U.S. Federal Trade Commission (FTC) released a similar report stating that increased vertical integration has allowed the six largest PBMs to handle nearly 95% of all prescriptions in the U.S. The FTC’s findings highlight concerns over the power PBMs have concerning patients’ access and affordability of medications, pointing to potential conflicts of interest that could disadvantage independent pharmacies and inflate drug costs for consumers.
FTC Chair Lina M. Khan emphasized that these intermediaries are “overcharging patients for cancer drugs,” contributing over $1 billion to their earnings.