PBM Execs Testify Before Congress About High Drug Prices

It was pharmacy benefit managers’ (PBMs’) turn to testify before Congress during an April 9 Senate Finance Committee hearing as part of an ongoing investigation into high prescription drug prices.

Executives from CVS Health’s Caremark, UnitedHealth’s OptumRx, and Cigna’s Express Scripts – representing a combined 76 percent of the U.S. market – testified on behalf of PBMs, which manage prescription drug coverage for clients that include employers, insurers, and unions.

Critics see PBMs as middlemen who add unnecessary costs to prescription drugs, while PBMs shift the blame to pharmaceutical companies, who they contend are responsible for setting drugs’ initial prices so high. Drugmakers, in turn, say the rebates negotiated by PBMs are partially to blame for high costs.

Members of the committee pushed PBMs to share details of the contracts they negotiate and explain why they can’t do more to control prices. “Whether PBMs bring any real value to taxpayers is a mystery,” said Sen. Ron Wyden (D-OR). “[They guard their operations] with greater secrecy than HBO is guarding the ending of ‘Game of Thrones.’”

Express Scripts and Sanofi have bowed to political pressure on insulin pricing: The former has promised that patients will pay no more than $25 per month for the medication, while the pharmaceutical company will lower insulin costs for the uninsured to $99 per month.

According to The Washington Post, House leaders expect a vote on measures that would bring more transparency to drug pricing in early May.

Sources: The Washington Post, April 11, 2019; AP News, April 9, 2019.