Senators press PBMs to clarify Azar's ‘extremely disturbing' drug pricing allegations

Two senators have asked prominent pharmacy benefit managers to address accusations from the Trump administration’s top health official that PBMs are preventing drug manufacturers from lowering prices.

In letters to nine PBMs, including Express Scripts, CVS Health and OptumRx, Sens. Elizabeth Warren, D-Mass., and Tina Smith, D-Minn., asked the companies to explain statements made by Department of Health and Human Services Secretary Alex Azar that PBMs have blocked voluntary priced reductions by drug makers. Those accusations could prompt antitrust concerns, the senators said. 

In hearings before two separate Senate committees last month, Azar suggested PBMs were creating hurdles for pharmaceutical companies who want to lower the list price by threatening to remove the drug from their formulary. His statements came several weeks after President Donald Trump promised several companies would be issuing voluntary price reductions.

"I would encourage the Senate and Congress to inquire of pharmacy benefit managers as to whether they have received suggestions or approaches from drug companies for lower list prices and what has the reaction been," he told members of the Senate Finance Committee last week. 

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“These are extremely disturbing allegations by Secretary Azar,” the senators wrote (PDF). “If they are true, these allegations suggest that PBMs and drug distributors are acting to maintain high list prices in order to maintain high profit margins, potentially raising antitrust concerns.”

In addition to CVS Health, Express Scripts and OptumRx, the senators sent letters to executives at CardinalHealth, McKesson, AmerisourceBergen, Medimpact Healthcare System, Prime Therapeutics and Humana.

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If Azar’s comments are true, they “directly contradict” public statements from PBMs regarding their role in reducing drug prices, the lawmakers said. They included a list of questions requesting more detail about discussions the companies have had with drug makers, whether they “pushed back” on lower list prices, and whether they threatened to remove drugs from their formulary.

They requested answers no later than July 13.

In a statement following last week’s Senate Finance hearing on drug prices, the Pharmaceutical Care Management Association’s President and CEO Mark Merritt placed the onus on manufacturers.

“The easiest way to lower costs would be for drug companies to lower their prices,” he said.