Illustration: Rebecca Zisser/Axios
Executives of the three biggest PBMs faced tough questions from both sides of the aisle at a House Oversight Committee hearing today, as scrutiny of the sector's business practices ramps up.
Why it matters: The hearing demonstrated the range of areas lawmakers are looking to address, including steering patients to certain pharmacies and not fully passing on discounts to patients.
What they're saying: Chair James Comer pushed back on efforts from Adam Kautzner of Express Scripts, David Joyner of CVS Caremark and Patrick Conway of OptumRx to blame drug manufacturers for high drug prices.
- "We hear that you're the problem," he said. "There's a credibility issue with the PBMs, there's a transparency issue with the PBMs."
- Ranking Member Jamie Raskin blamed both drug manufacturers and PBMs for high costs.
Driving the news: Raskin pressed the executives on why a patient with insurance would sometimes need to pay more for a drug than if they paid out of pocket.
- Joyner appeared to acknowledge some room for improvement on that front. "I am trying to change and transform the marketplace, which is in large part why we introduced True Cost," he responded, pointing to a CVS program aiming to provide more transparency.
- He said that program would "actually eliminate many of the headlines that you're referencing."
- Raskin expressed some frustration at the complexity of the drug supply chain and the executives' responses. "I feel like the more I hear, the less I understand," he said.
The other side: The executives defended their role as helping keep drug costs down for insurance plans and covered individuals.
- "Last year alone we saved our clients $64 billion, and we kept patient out-of-pocket costs on a per-prescription basis at just $15, despite brand manufacturers raising drug prices on 60% of those products," Kautzner said. "It's hard work to keep those costs down for patients and clients."
- Comer, though, also raised concerns from independent pharmacies, and asked the executives to commit not to steer patients to their own pharmacies.
- "I'm going to take that as an answer [that] you're going to continue to steer patients away from independent pharmacies," he said, expressing dissatisfaction with the responses.
