The presidents of CVS Caremark and Express Scripts and the CEO of Optum Rx testified, and all three made claims that are directly contradicted by evidence cited in the letters.
On August 28, 2024, the U.S. House Committee on Oversight and Accountability issued letters to executives of three of the nation's largest pharmacy benefit managers (PBMs), accusing them of providing false testimony before Congress. Each letter outlines the allegedly false statements and the evidence that the statements contradict. They also outline the statutory penalties for perjury before Congress—namely, monetary fines and imprisonment for up to five years. The letters give the PBMs until September 11, 2024, to correct the Congressional Record.
On July 23, 2024, the committee held a hearing on "The Role of Pharmacy Benefit Managers in Prescription Drug Markets." The presidents of CVS Caremark and Express Scripts and the CEO of Optum Rx testified, and all three made claims that are directly contradicted by evidence cited in the letters. For example, all three executives testified that their PBMs do not steer patients to PBM-owned pharmacies, meaning requiring patients or providing financial incentives for patients to purchase medications from PBM-owned pharmacies, as opposed to independent pharmacies. The letters quote this testimony and then cite evidence from a committee report, a recently released Federal Trade Commission (FTC) report and direct patient testimony demonstrating that PBMs do, in fact, steer patients to PBM-owned pharmacies. The letters follow this same formula in disputing the following claims made by these executives:
- CVS Caremark and Optum Rx pay nonaffiliated pharmacies rates comparable to or greater than what they pay affiliated pharmacies.
- Express Scripts allows nonaffiliated pharmacies to redline and negotiate their contracts.
- Optum Rx does not engage in opt-out contracting, a practice whereby PBMs add terms to their pharmacy contracts by sending a notice to pharmacies and saying that if a pharmacy does not affirmatively opt out of the proposed new terms, it accepts them.
PBMs continue to be under federal and state scrutiny, including from the Department of Justice's newly created Task Force on Health Care Monopolies and Collusion, the FTC, Congress and multiple state attorneys general. We will continue to monitor the situation as it develops.
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