Feds open another probe into PBM practices

Nine months after the Federal Trade Commission launched an inquiry into pharmacy benefit practices, the House Committee on Oversight and Accountability opened an investigation March 1. 

The latest federal probe is based on alleged anticompetitive practices, which committee Chair Rep. James Comer of Kentucky said increases healthcare costs and harms patients. 

"Greater transparency in the PBM industry is vital to determine the impact that their tactics are having on patients, the pharmaceutical market and healthcare programs administered by the federal government," Mr. Comer said.

The House committee's investigation focuses on three PBMs that control 80 percent of the market — CVS Caremark, Express Scripts and OptumRx — three fewer than the FTC's probe, which includes Humana, Prime Therapeutics and MedImpact Healthcare Systems. 

Two senators recently renewed efforts into inspecting PBM practices with the Pharmacy Benefit Manager Transparency Act and the Prescription Pricing for the People Act. 

The National Community Pharmacists Association applauded the effort and the "momentum [that] is clearly building in Washington in favor of PBM transparency and reforms."

"The tide in Washington seems to be turning, with this latest investigation and other ongoing efforts offering hope that changes will be coming," NCPA CEO Douglas Hoey said in a March 1 news release

In a survey involving recent pharmacy graduates, longtime practitioners and pharmacy owners, 91.5 percent of respondents said PBM practices are negatively affecting their practice and their ability to provide patient care. The American Pharmacists Association survey was conducted from Jan. 28 to Feb. 15, and a large majority of the 500 respondents said patient steering, clawback fees, spread pricing and low reimbursements are hurting their business and their patients. 

In response to the results, APhA Interim Executive Vice President and CEO Ilisa Bernstein, PharmD, said, "PBM reform is needed now."

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