Executives of the three biggest PBMs will be in the hot seat tomorrow when the House Oversight Committee drills down on whether the companies are contributing to high drug costs, Peter reports.

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 them 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: The expectation is there will be tough questions from lawmakers from both parties.

• 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.

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.

1. PBM oversight: The House Oversight Committee holds a hearing tomorrow at 10am ET with executives from top PBM's CVS Caremark, Express Scripts and OptumRx (see coverage above).

2. Steward Health: The Senate HELP Committee meets Thursday at 10am ET to weigh subpoenaing Steward Health CEO Ralph de la Torre as part of an investigation into the bankruptcy of the health network.

3. CDC's mission: The House Energy and Commerce health subcommittee holds a hearing titled "Are CDC's Priorities Restoring Public Trust and Improving the Health of the American People?" tomorrow at 10:30am ET.