The House Committee on Oversight and Government Reform announced an investigation into pharmacy benefit managers Optum Rx, CVS Caremark and Express Scripts Oct. 23, reviewing their auditing practices of independent pharmacies.
The investigation stems from concerns “that independent pharmacies have potentially been targeted for punitive audits in retaliation for their public support of legislation recently passed by the committee,” the committee’s chairman, James Comer, R-Ky., said.
Under HR 6610, PBMs for Federal Employees Health Benefits Program plans would pay in-network pharmacies a benchmark price with a capped margin. The PBMs would also pay a dispensing fee that aligns with what the state Medicaid program pays. The Pharmaceutical Care Management Association, which represents PBMs, pushed back against the bill amid the committee’s July markup.
“Let’s understand this bill for what it is: a huge cash transfer from taxpayers to pharmacists and nothing more,” PCMA President and CEO David Marin said in a July 22 statement. “It makes providing health benefits to federal workers far more expensive, simply as a gift to one industry.”
Mr. Comer said that since the July markup, several independent pharmacies that backed the bill received more audit notices than usual.
“This raises concern that these audit notices were sent or timed to retaliate for their support of HR 6610,” he said.
According to a news release from the committee, one audit concerned a $0.99 medication. The committee said the audit took the pharmacy’s staff “hundreds of hours.”
“We have received Chairman Comer’s letter, and we plan to respond to the committee,” a CVS spokesperson told Becker’s. Optum Rx declined a request for comment.
Becker’s has reached out to Express Scripts and will update this story if more information becomes available.
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