House Launches Investigation into Nation’s Largest PBMs

The U.S. House Committee on Oversight and Accountability has launched an investigation into the nation’s top three pharmacy benefit managers and their practices: CVS Health, Cigna, and UnitedHealth Group.

The committee is concerned with how PBMs affect drug costs overall and the prices patients pay at the pharmacy counter and in their health insurance premiums. Their role in the rising cost of healthcare has created financial instability for both consumers and independent pharmacies.

Some key findings of the investigation so far include:

• PBMs engage in "spread pricing," where they charge insurers more for a drug than they pay pharmacies for, leading to higher costs for patients and insurers.
• They use their market power to negotiate discounts from drug manufacturers, without passing these savings on to patients or insurers.
• "Gag clauses" in contracts with pharmacies prevents pharmacists from informing patients when they can save money by paying cash instead of using their insurance.
• PBMs may steer patients to specific pharmacies, instead of allowing patients to choose their preferred pharmacy.

The investigation will bring more transparency into the PBM industry and the way that their tactics influence patients, programs, and the pharmaceutical market.

PBMs have a significant impact on our members’ businesses, which is why independent pharmacists should be aware of the investigation and its findings. Learn more here and stay up to date with AAPA as we bring you more developments as they occur.

At AAPA, we have been advocating for better policies and fighting to keep the pressure on legislators to take action. While this announcement is only the first step in an intricate process, we are glad to see that the journey forward has begun.