Rep. Comer Highlights Profit Prioritization by Pharmacy Benefit Managers

Three large Pharmacy Benefit Managers (PBMs) monopolize the pharmaceutical market and engage in self-benefiting practices that boost their profits without benefiting patients, House Committee on Oversight and Accountability Chairman James Comer said on Tuesday at a hearing on the subject, according to a press release from the panel

The Kentucky Republican emphasized that “greater transparency and accountability is needed in the PBM industry, because their tactics are causing Americans to suffer from increasing health care premiums and expensive prescription drug prices.”

Comer described how these “deliberate, anticompetitive pricing tactics seek to prevent payers — including government ones like Medicare, Medicaid, Tricare, and the Federal Employee Health Benefits program — from understanding how PBMs are making billions at the expense of patients and taxpayers.”

Comer, after noting the PBM committee report released in 2021, said the panel will continue to exert efforts to highlight how PBMs undermine health practices and attempt to find legislative solutions for the problem.

Comer explained that “PBMs started out as beneficial additions to the healthcare system, because they were competing with each other to provide clarity to pharmacies, payers, and patients about drug costs.”

However, he bemoaned that this “environment of competition and transparency is no longer true today,” citing that “instead of fierce competition, the situation is such that just three PBMs control 80% of the market.”

Comer pointed out that “each of the three major PBMs — CVS Caremark, Express Scripts, and Optum Rx — is owned by a major health insurer and owns, or is owned, by a pharmacy. This means that when PBMs negotiate with a pharmacy or a health insurer, they are either negotiating with themselves or one of their direct competitors.”

The congressman said that “this can create incentives to do things that have negative impacts on patients,” which he stressed is “why the committee’s examination of PBMs is a priority this Congress.”