An investigation by federal lawmakers found that pharmacy-benefit managers promised to control costs but have instead steered patients toward higher-priced medicines and affiliated pharmacies that reduce patient choice, The Wall Street Journal reported July 23.
A House Committee on Oversight and Accountability investigation found PBMs devised formulas for preferred medications that encouraged use of higher-priced drugs. It also found that Express Scripts sent messages to patients saying they would pay more to fill at their local pharmacy, but less for a three-month supply by using the affiliated mail-order pharmacy.
"While this is made to appear to benefit the patient, what it is instead doing in practice is limiting a patient's ability to choose their own pharmacy," the committee wrote.
The report followed a 32-month investigation. Leaders from three large PBMs are set to testify before the House committee this week.
A Pharmaceutical Care Management Association spokesperson told the Journal the firms help reduce costs to patients and health plans. He declined to comment on the report because the organization had not seen it.
"The critically important role of PBMs in our healthcare system in driving affordable access to prescription drugs is undeniable, saving patients and health plans $1,040 per person per year on drug costs," the spokesperson said.
The three largest PBMs — CVS Caremark, Cigna's Express Scripts and UnitedHealth's OptumRx — handle 79% of U.S. medical prescriptions for approximately 270 million people. Integrating further with health insurers allows even more control over medication prices and access, according to a Federal Trade Commission report issued in July. On top of that, PBMs contributed to a 10% closure rate of independent pharmacies in rural locations between 2013 and 2022.
An investigation by the FTC into pharmacy benefit managers revealed PBM favoritism toward their own pharmacies and vast market control, which affects both medication access and affordability, according to the agency's report.
The House committee also criticized the largest PBMs for lack of transparency and said they sent House investigators only a handful of pages about the groups they established to buy drugs, the Journal reported.