A new report from the House Committee on Oversight and Accountability reveals that pharmacy-benefit managers (PBMs) are directing patients towards higher-cost medications while restricting their choices of where to obtain them.
The report, which was accessed by the Wall Street Journal, comes after a 32-month investigation into the practices of PBMs as the committee prepares for a hearing featuring executives from the largest PBM organizations in the country.
PBMs act as intermediaries managing prescription drug plans for health insurers, negotiating prices with pharmaceutical companies on behalf of health plans, and determining 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.
According to the committee’s findings, these managers are favoring higher-priced brand-name drugs over less expensive options on their preferred drug lists. The report highlights emails from Cigna that advised against using more affordable alternatives to Humira, a treatment for arthritis, despite the availability of a biosimilar at half the cost.
Additionally, Express Scripts reportedly informed patients that filling a prescription at their local pharmacy would be more costly than ordering a three-month supply through their affiliated mail-order service, which limits patient pharmacy choices.
Earlier this month, the U.S. Federal Trade Commission (FTC) released a similar report, indicating that the concentration of power among the six largest PBMs has allowed them to manage nearly 95% of prescriptions filled in the United States.
The FTC expressed concern regarding the influence of leading PBMs on patients’ access and affordability of prescription drugs. The commission noted that the existence of vertically integrated PBMs leads to conflicts of interest that can disadvantage independent pharmacies and increase drug costs for consumers.
FTC Chair Lina M. Khan pointed out that these intermediaries are overcharging patients for cancer treatments, reportedly generating over $1 billion in additional revenue from these practices.