House Oversight Committee Holds Hearing on the Role of Pharmacy Benefit Managers in Prescription Drug Markets

On September 19, 2023, the House Committee on Oversight and Accountability held a hearing  titled, “The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part II: Not What the Doctor Ordered.” During this hearing, the Committee took testimony from several industry witnesses shedding light on the effect of abusive practices by Pharmacy Benefit Managers (PBMs) on the pharmaceutical supply industry. This most recent hearing follows the Committee’s May 23, 2023 hearing on the same subject, as well as the March 30, 2023 Senate Committee on Finance hearing, where Frier Levitt’s co-founding partner, Jonathan Levitt, Esq., testified at length on PBM misconduct.  This recent hearing reinforced the bipartisan trend to unveiling secretive PBM actions and advancing regulatory measures within the industry.

Prominent representatives, notably Chair Comer (R-Ky) and ranking member Raskin (D-Md), maintained calls for bipartisanship in addressing PBM regulation.  The consensus among bipartisan committee members was that PBMs need to be regulated.  Many Committee members showed significant concern for market concentration and vertical integration that has led to over 80% of all prescriptions being managed by only three PBMs (Caremark, OptumRx, and Express Scripts).  These themes are consistent with current trends in the House and Senate, as well as the work and public statements of the Federal Trade Commission (FTC). The FTC is currently investigating PBMs, has restated its Section 5 Policy to expansively enforce against the kinds of unfair methods of competition in which PBMs engage, and most recently, has withdrawn its prior PBM advocacy.  The bipartisan committee and the FTC appear to agree that PBM abuses are a danger to the public and need to be addressed promptly.

The hearing also delved into the impact of rebates on drug prices, as well as DIR fees and the effect of these on patients and pharmacies.  Chair Comer called for the Committee to continue investigating and to find meaningful solutions for PBM abuse in a bipartisan manner. In his final statement, Comer offered his opinion that there is overwhelming bipartisan support for solving the problem of vertical integration in the PBM industry.

How Frier Levitt Can Help

Frier Levitt has been at the forefront of the push for federal legislation to address PBM abuses and has advocated on behalf of providers and associations directly to government agencies, including the Centers for Medicare and Medicaid Services (CMS) and the FTC, among others.  Frier Levitt has also had great success advocating for pharmacies against PBM abuses, including unfair and abusive audit practices and DIR fees. Call Frier Levitt today to learn more.