Illustration: Annelise Capossela/Axios
Executives of the nation's three biggest PBMs will be in the hot seat Tuesday when the House Oversight Committee drills down on whether the companies are contributing to high drug costs.
Why it matters: It's the latest sign of intensifying bipartisan scrutiny on PBMs and could help build momentum for overhauling their business practices in a year-end package — even though the Oversight panel isn't the primary venue for legislative action.
What they're saying: "The hearing really is trying to continue to keep the focus on PBMs going forward," said Raymond James analyst Chris Meekins.
- "It matters if any of them make a big, massive mistake," he added. "But short of that, I don't think we're going to materially see new information."
Driving the news: Top executives of the three major PBMs will testify: Adam Kautzner, president of Express Scripts, David Joyner, president of CVS Caremark and Patrick Conway, CEO of OptumRx.
- Expect the PBMs to try to shift the focus to drug manufacturers, which they say set the list prices that are a starting point in negotiations, and to defend their function as lowering costs, not raising them.
- "Far too many conversations on PBMs reflect a one-sided view informed directly by drug companies' blame game designed to vilify PBMs to keep prescription drug prices high and increase drug company profits," said Greg Lopes, a spokesman for the Pharmaceutical Care Management Association.
- Kautzner plans to highlight Express Scripts data showing that consumers with employer-sponsored coverage paid less out of pocket for drugs in 2023 than in 2022, and that the average cost of a 30-day prescription was $15.
The other side: Expect tough questions from both parties at the hearing.
- Oversight Chair James Comer pointed to spread pricing, in which PBMs can charge payers more than they pay a pharmacy for a drug, and the role of rebates.
- PBMs' treatment of community pharmacies is also a favorite topic of lawmakers, given that many members hear from them in their districts.
- "Both Republicans and Democrats on the House Oversight Committee have sounded the alarm over anticompetitive tactics deployed by pharmacy benefit managers and their role in rising drug prices," Comer said in a statement.
- "PBMs have been allowed to hide in the shadows for far too long," he added.
The bottom line: The hearing could focus attention on legislation addressing transparency requirements, "delinking" PBM compensation from the price of a drug and banning spread pricing.
- Congress will still need to narrow down a flurry of competing proposals on those fronts, across a variety of committees, if it is actually going to get policy changes across the finish line this year.
