A key legislator is accusing the leaders of the three largest pharmacy benefit managers of making fraudulent statements during a hearing last month on the industry.
Rep. James Comer, chair of the House Committee on Oversight and Accountability, sent letters to the three PBMs calling for the CEOs to "correct" statements made to the panel that he says contradict findings from both the committee and the Federal Trade Commission (FTC).
Under scrutiny are statements made about PBMs' relationships with local pharmacies. Adam Kautzner, president of Express Scripts; David Joyner, president of CVS Caremark; and Patrick Conway, M.D., CEO of Optum Rx all spoke at the July hearing and said their firms do not steer patients toward pharmacies owned by the PBM or its affiliated companies.
Comer also said the executives "made claims contradicting the Committee’s and FTC’s findings regarding contract negotiations, contract opt outs, and payments to pharmacies."
In the letters, Comer said the alleged perjury would come with a punishment including fines and up to five years in jail. The letters give the executives until Sept. 11 to correct the record.
Spokespeople for CVS and Optum Rx told Fierce Healthcare they are reviewing the letters.
"We stand firmly behind Dr. Kautzner’s testimony and strongly refute and disagree with this letter’s allegations. We are proud of the work our clinicians and teams do every day to improve health and lower the cost of medications for the millions of Americans we serve," a spokesperson for Express Scripts said.
In July, the FTC released the results of its investigation into the business practices of major PBMs, expressing concern about the massive market share the three largest firms have. Collectively, they control 80% of the PBM market.
All three are also part of large, vertically integrated healthcare companies. Caremark is a subsidiary of CVS Health and a sister company to insurer Aetna. Express Scripts, meanwhile, is a part of the Cigna Group's Evernorth division. Optum Rx is a segment within industry behemoth UnitedHealth Group.
While the report stopped short of saying that major PBMs should be broken up, it did say additional regulation of the industry would likely be necessary. It notes that the vertically integrated nature of these companies incentivizes them to direct PBM members to in-house pharmacies or other services to the detriment of independent facilities.
Earlier this week, the Pharmaceutical Care Management Association highlighted a study from Dennis Carlton, Ph.D., professor emeritus at the University of Chicago Booth School of Business and former chief economist at the U.S. Department of Justice Antitrust Division, that it says "debunks" the findings that PBMs are forcing independent pharmacies to close.
The study shows that the number of independent pharmacies has increased, and gross margins are stable. It also concluded that PBM-affiliated pharmacies receive payments that are about 4% lower than non-affiliated pharmacies for the same drugs.