"PBM chief executives made statements that contradict the committee’s and the Federal Trade Commission’s findings about the PBMs’ self-benefitting practices that jeopardize patient care, undermine local pharmacies and raise prescription drug prices," the oversight committee said in a news release Wednesday.
Express Scripts rejected Comer's accusations. “We stand firmly behind Dr. Kautzner’s testimony and strongly refute and disagree with this letter’s allegations. We are proud of the work our clinicians and teams do every day to improve health and lower the cost of medications for the millions of Americans we serve,” a spokesperson said in a statement. Express Scripts is a division of Cigna subsidiary Evernorth. Kautzner holds a doctorate in pharmacy and is not a medical doctor.
CVS Caremark is a subsidiary of CVS Health and OptumRx is a division of UnitedHealth Group subsidiary Optum. Neither of those companies nor the Pharmaceutical Care Management Association, a PBM trade group, responded to requests for comment.
Comer's letters include quotations from Joyner, Kautzner and Conway at the hearing, which was part of a series of sessions examining the role of PBMs in the healthcare system.
Comer alleges the executives gave untrue or misleading answers to questions about matters such as whether their companies steer patients to pharmacies they own, whether they strong-arm drugstores to participate in their networks, and whether they make sudden, take-it-or-leave-it revisions to existing contracts with pharmacies.
According to the committee's findings and the ongoing FTC probe, PBMs do direct patients to their own pharmacies and exert monopoly-like power over independent pharmacies that leaves them in contracts that change at a moment's notice and with disadvantageous payment terms that harm smaller, local drugstores.
The letters highlight specific statements that caught Comer's attention.
For instance, according the committee's research, small pharmacies have little to no power to negotiate terms with PBMs. Comer cites evidence the committee collected that Express Scripts has asserted to drugstores that "rates are non-negotiable" and that "the rate exhibit provided offers our best and final rates."
Comer compares that to Kautzner telling Rep. Russell Fry (R-S.C.) at the hearing, "We are always open, Congressman, to negotiating with pharmacies. ... [P]harmacies can always redline a contract back to us and negotiate."
The letters highlight similar exchanges lawmakers had with Joyner and Conway.
Rep. Pat Fallon (R-Texas) asked Joyner if he would say his company had a positive relationship with independent pharmacies. Joyner replied, "I would, and we also reimburse them more money, so I think that is one of the benefits of a relationship."
Comer's letter counters that the committee has "received evidence that that CVS Caremark reimburses competing pharmacies below the acquisition cost of the medication and below what it reimburses pharmacies it owns."
In another example, Fallon asked the executives if they steered patients to affiliated pharmacies. They all said no. The letter to Conway states, "This statement contradicts both the committee’s and Federal Trade Commission’s findings that OptumRx, as well as Express Scripts and CVS Caremark, steer patients to PBM-owned pharmacies."
Geoffrey Joyce, director of health policy at the University of Southern California Schaeffer Center for Health Policy and Economics, said Comer raises valid questions.
"Comer’s three main points are broadly correct," Joyce wrote in an email. "PBMs are not fiduciaries and have won in court supporting the right to act in their own interests and not the interest of their clients," he wrote.
Intense scrutiny from the Oversight and Accountability Committee suggests a "reckoning" is coming for the PBM industry, National Community Pharmacists Association CEO Douglas Hoey said in a news release Wednesday.
"Congress and the FTC aren’t falling for their nonsense, and the heat on them has never been higher," Hoey said. "PBM-insurers exert so much influence on which drugs patients have access to and how much they cost that calling out their mistruths and working to hold them accountable is critical, and we applaud Chairman Comer for doing so."
The National Community Pharmacists Association, which has warred with PBMs for decades, supports stalled legislation that would impose new restrictions on PBMs.
