A recent report from the House Committee on Oversight and Accountability reveals that pharmacy-benefit managers (PBMs) are pushing patients toward pricier medications while restricting their pharmacy options.
The findings were highlighted ahead of a committee hearing featuring executives from the nation’s biggest PBMs. According to the Wall Street Journal, this report stems from a 32-month investigation.
PBMs, which serve as intermediaries for health insurers, negotiate drug prices with pharmaceutical companies and determine patients’ out-of-pocket costs. The three largest PBMs in the U.S.—Express Scripts, UnitedHealth Group’s OptumRx, and CVS Health’s Caremark—manage about 80% of all prescriptions in the country.
The committee’s investigation concluded that PBMs have compiled preferred drug lists that favor higher-priced brand-name medications over more affordable options. For instance, the report referenced Cigna emails discouraging the use of cheaper alternatives for Humira, an arthritis and autoimmune treatment costing $90,000 annually, despite the availability of a biosimilar for half that price.
Additionally, Express Scripts reportedly informed patients that filling prescriptions at local pharmacies would be costlier than obtaining a three-month supply from their mail-order pharmacy, effectively limiting patient choices.
A similar report from the U.S. Federal Trade Commission (FTC) highlighted that increasing consolidation among PBMs allows the six largest firms to manage nearly 95% of prescriptions in the U.S. The FTC expressed concerns over the significant power PBMs have over access to and affordability of prescription medications. Their findings indicated that these vertically integrated PBMs might prioritize their own affiliated businesses, creating conflicts of interest that could disadvantage independent pharmacies and inflate drug costs.
FTC Chair Lina M. Khan emphasized that these middlemen are profiting off the excess charges for cancer drugs, generating more than $1 billion in additional revenue at the expense of patients.