WASHINGTON- Today, Congressman James Comer (R-Ky.) published an op-ed on his Oversight Committee investigation which has exposed how the three largest Pharmacy Benefit Managers (PBMs)—CVS Caremark, Express Scripts, and OptumRx—monopolized the pharmaceutical marketplace by deploying anticompetitive pricing tactics that are raising prescription drug prices, undermining community pharmacies, and harming patients across the United States.
Read Congressman Comer’s op-ed below:
As I travel across Kentucky’s 1st Congressional District, rarely a day goes by that I don’t hear from Kentuckians concerned about the high cost of prescription drugs.
The numbers don’t lie. Cost of life-saving medications have gone up every single year for the past fifteen years.
Americans now spend more on prescription drugs—about $1,200 per person—than any other country.
Patient out-of-pocket costs for prescriptions were $91 billion in 2023 alone.
This is definitely not what the doctor ordered.
Despite these increases in healthcare costs, life expectancy in America has remained stagnant.
That means someone is benefitting here, and it clearly isn’t Kentuckians.
In 2021, I began to use the power of the House Oversight Committee to examine the pharmaceutical marketplace and the middlemen of the drug supply chain: pharmacy benefit managers (PBMs).
PBMs were first created to benefit the entire health care system. Dozens of large PBMs nationwide competed and initially provided clear details about costs, fees, and rebates to pharmacies and patients.
But now, instead of fierce competition, three large PBMs—CVS Caremark, Express Scripts, and Optum Rx—collectively control 80 percent of the market. Today, these three PBMs operate in the dark and engage in self-benefitting practices that line their own pockets and pass the costs on to you.
As Chairman of the House Oversight Committee, I recognized that Congress must act and made it a top priority to expose these anticompetitive tactics pushed by PBMs that are driving up the cost of prescription drug prices for all Americans.
Over the course of my investigation, the Oversight Committee has collected over 140,000 pages of documents, communications, and information on America’s three largest PBMs.
We now know PBMs share patient information and data across their many integrated companies for the specific and anticompetitive purpose of steering patients to pharmacies a PBM owns.
We now know PBMs have sought to use their position to artificially reduce reimbursement rates for competing pharmacies.
We now know PBMs push spread pricing schemes to overcharge plans and payers by hundreds of millions of dollars.
We now know PBMs prioritize higher cost medications, even when there are lower-cost and equally safe and effective competing options.
This evidence obtained by the Oversight Committee and released to the public shows PBMs raise prescription drug prices, like insulin, undermine our local pharmacies, and harm Kentuckians who need access to affordable medication.
Since 2023, I have also led three Oversight Committee hearings to conduct oversight and examine these abusive PBM practices.
I even dragged the Chief Executive Officers from the three largest PBMs before Congress.
I made it clear their Pharmacy Benefit Mafia is coming to an end.
I am working with my colleagues across the aisle to advance bipartisan solutions to ensure greater transparency and accountability in the PBM industry.
I’m supporting the Pharmacists Fight Back Act, bipartisan legislation that aims to combat price gouging deployed by PBMs.
Earlier this year, the Oversight Committee passed—with broad bipartisan support—the Delinking Revenue from Unfair Gouging (DRUG) Act which would reign in abusive practices by some PBMs that offer health plans under the Federal Employees Health Benefits program.
In fact, the Federal Trade Commission (FTC) just announced it is taking action against the three largest PBMs and suing their group purchasing organizations for engaging in anticompetitive tactics that are inflating the price of insulin drugs.
This move by the FTC is a direct result of the House Oversight Committee’s investigation into PBMs.
Kentuckians and Americans across the nation deserve access to affordable, life-saving drugs.
Republicans and Democrats on the House Oversight Committee will continue to consider legislative solutions to hold PBMs accountable.
It’s time for PBMs to have a taste of their own medicine.
Our work is not done.
Rep. James Comer is a United States Congressman for Kentucky’s 1st Congressional District and Chairman of the House Committee on Oversight and Accountability.
(Austin Hacker – Office of Congressman James Comer)