Washington: A recent report by the House Committee on Oversight and Accountability reveals that U.S. pharmacy benefit managers (PBMs) are steering patients toward more expensive medications, even when lower-cost alternatives are available.
According to the committee, evidence shows that PBMs require drugmakers to pay rebates in exchange for favorable placement of their branded drugs on formularies—the lists of medications covered by insurance plans.
A hearing by the U.S. House of Representatives oversight panel, featuring executives from the top three U.S. PBMs—UnitedHealth’s OptumRx, Cigna’s Express Scripts, and CVS Health’s Caremark—is currently underway.
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PBMs, which manage prescription drug benefits for health insurance companies, large employers, and Medicare plans, have reportedly used their influence to implement anti-competitive practices and protect their profit margins.
The committee’s report also highlights concerns about PBMs sharing patient data across their various integrated units to direct them towards pharmacies they own. Additionally, some PBMs have moved certain operations overseas to circumvent transparency and proposed reforms.
