A recent report from the House Committee on Oversight and Accountability has raised significant concerns about the practices of pharmacy-benefit managers (PBMs), claiming they are directing patients toward more expensive medications while simultaneously restricting their pharmacy options.
This comprehensive examination, which spanned 32 months, preceded a hearing featuring executives from the largest PBMs, including Express Scripts, OptumRx, and Caremark. These three entities are responsible for managing nearly 80% of the prescriptions in the U.S.
The report highlights that PBMs often produce lists of preferred medications that favor higher-priced brand names over more affordable alternatives. A stark example cited is Cigna’s communication discouraging the use of lower-cost alternatives to Humira, a widely prescribed arthritis medication that costs patients approximately $90,000 annually, despite the availability of a biosimilar priced at half that amount.
Additionally, there are findings indicating that Express Scripts informed patients they would incur higher costs by using their local pharmacies instead of opting for a three-month supply through its affiliated mail-order service. This practice restricts patients’ choices and potentially leads them to spend more on their prescriptions.
The U.S. Federal Trade Commission (FTC) has echoed these concerns in a recent report, asserting that increased consolidation within the industry allows the largest PBMs to manage 95% of prescription fill operations in America. According to the FTC, this concentrated power raises alarms about patients’ access to affordable medications and creates a setting where PBMs may prioritize their own affiliated services over those of independent pharmacies.
FTC Chair Lina M. Khan pointed out that these practices may lead to “overcharging patients for cancer drugs,” resulting in over $1 billion in additional revenue for the middlemen involved.
This report and its findings bring attention to an essential aspect of healthcare in America, fostering public awareness and potentially prompting legislative change to ensure that patients receive better access to affordable medications. It also paves the way for future investigations into the practices of PBMs, which could lead to reforms aiming to enhance transparency and competition in the pharmaceutical landscape.
In summary, the ongoing scrutiny of pharmacy-benefit managers is a hopeful sign that consumers might gain better access to affordable medications, helping to reduce the financial burden on patients across the nation.