On September 2, 2025, House Representative James Comer, Chairman of the House Committee on Oversight and Government Reform, issued letters to presidents/CEOs of both the Cigna Group (parent of Pharmacy Benefit Manager (“PBM”) Evernorth/Express Scripts) and Optum Rx. The letters seek information and production of documents regarding the PBMs’ overseas rebate aggregators, also known as group purchasing organizations (“GPOs”), Ascent Health Services (“Ascent”) and Emisar Pharma Services (“Emisar”). Ascent is headquartered in Switzerland, while Emisar is based out of Ireland.
These investigational letters, which effectively function as document demands under Congress’s broad investigational and oversight powers, follow the House Oversight Committee’s July 2024 report titled “The Role of Pharmacy Benefit Managers in Prescription Drug Markets,” on the many ways in which pharmaceutical middle-men profit from the U.S. drug supply chain at the cost of patients. That report concluded that the increasing dominance of the major PBMs such as Caremark, Express Scripts, and OptumRx have led to higher drug costs, fewer choices for consumer patients, and ultimately worse patient outcomes. The House Oversight Committee further found that “PBMs inflate prescription drug costs and interfere with patient care for their own financial benefit.” Part of the report addressed how some of the PBMs had created offshore GPOs to generate additional rebates and fees while injecting opacity and avoiding domestic PBM disclosure requirements.
That same month (July 2024), the Federal Trade Commission (“FTC”) published another report with similar findings, focusing on the PBMs’ use of particular business tactics including patient steering, vertical integration that disadvantage independent pharmacy providers, and which inflate drug costs for patients. These investigational reports appeared to reflect a paradigm shift in the focus and interest taken by federal agencies and congressional entities into the impact of PBMs on rising prescription drug costs in the United States.
Documents Demanded by the House Oversight Committee
Chairman Comer’s letters to Cigna and OptumRx continue the trend of heightened public scrutiny into PBMs, and in particular, the PBMs’ overseas GPO operations. Comer criticized these arrangements, stating that GPOs “appear to be yet another example of institutional intent at opacity and avoidance of oversight.” The letters suggest that Ascent and Emisar were “headquartered overseas” for the purpose of “retaining additional revenue and fees and to sidestep U.S. legislative and regulatory reforms.” The letters request detailed documentation on the operations of these subsidiaries, including:
- All corporate formation and organizational documents for Ascent and Emisar;
- All communications regarding the decision by the parent PBM to form the GPO;
- All policy documents regarding the GPOs’ compliance with U.S. federal and state PBM laws, regulations, and reporting requirements;
- All documents and communications by the GPO that utilize the terms rebates and fees;
- All contracts between the GPO and any PBMs.
It should be noted that these document demands are addressed to Cigna and OptumRx, not to the GPOs directly. Should Cigna and OptumRx respond by claiming that the PBM has zero access to their affiliated GPO’s records, such a response will not be taken well by the House Oversight Committee. Indeed, such a response would only confirm the Committee’s and FTC’s conclusions that the affiliates are headquartered overseas for the express purpose of bypassing U.S. transparency and oversight requirements.
Conclusion
These letters further escalate the level of public scrutiny against the PBMs and their GPOs. It remains to be seen whether Cigna and OptumRx will comply with the document demands. Frier Levitt will be closely following what information comes to light from these letters, as it likely will be relevant to Frier Levitt’s work to recover losses on behalf of Plan Sponsors against PBMs and GPOs.
How Frier Levitt Can Help
As noted above, Frier Levitt represents employers with self-funded plans in their dealings with PBMs. Our deep understanding of the legal landscape and PBM practices – including GPOs – uniquely positions us to conduct comprehensive audits. We assess contract compliance, financial accuracy, and performance metrics to ensure that your PBM arrangements align with fiduciary standards and your company’s financial interests.
If you are a plan sponsor that believes that PBMs and GPOs may have profited from your pharmacy benefits at the expense of your plan and plan members, contact Frier Levitt today to learn how our PBM audit services can fortify your defense against fiduciary breach claims and help to recover losses to your employee benefits plan.
Co-Managing Partner
Senior Associate
