PBMs head to Capitol Hill this week: 5 things to know

Alia Paavola - Print  | 

Pharmacy benefit managers, the middlemen who negotiate drug benefits for health plans, will head to Capitol Hill this week to face back-to-back hearings about their role in the pricing of prescription drugs.

What you need to know:

1. Back-to-back hearings in Senate, House. The Senate Finance Committee invited several major PBM executives to testify April 9 about their role in the drug industry. This hearing, initially scheduled for April 3, was delayed. The April 10 hearing, held by the House Energy and Commerce Oversight, will discuss drugmakers and PBMs' role in skyrocketing insulin prices.

2. Who is testifying? Top executives from five major PBMs, CVS Health, Cigna, OptumRx, Prime Therapeutics and Humana, will testify before the Senate Finance Committee on April 9.  Representing the companies will be: Derica Rice, executive vice president at CVS; John Prince, CEO of OptumRx; Steve Miller, MD, chief clinical officer at Cigna; Mike Kolar,  interim president of Prime Therapeutics; and William Fleming, Humana president of healthcare services. Three of those top executives, from CVS, Cigna and Optum, will face the House Energy and Commerce Oversight Committee on April 10.

3. What criticism will PBMs likely face? Pharmaceutical companies, pharmacists and physicians continually blame PBMs for rising prescription drug costs. President Donald Trump has blasted them as "middleman" who are "dishonest," according to STAT. The pharmaceutical industry has been accused of lacking transparency in how it handles rebates from PBMS and for not passing these discounts to patients at the pharmacy counter.

4. How PBMs are likely to respond. PBM executives will likely defend themselves by characterizing drugmakers as the villians who push list prices higher and pocket the most from prescription drug sales in the U.S. They will probably try to persuade lawmakers that they're valuable industry players whose rebate system and other mechanisms promote savings for the entire healthcare system, according to The Washington Post.

5. The drug-pricing hearings. The PBM industry's trip to Capitol Hill follows a major March hearing during which seven executives from major pharmaceutical companies faced a Senate grilling about the industry's role in the nation's high drug costs. The hearings come in the midst of increasingly bipartisan interest in lowering the price of prescription medicines.

More articles on pharmacy:
7 drugs projected to become blockbusters by 2023
3 insulin manufacturers to testify at House panel April 10
Cigna-Express Scripts cap out-of-pocket 30-day insulin costs at $25

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