House Committee Probes Whether Three PBMs Used Audits to Retaliate

House Oversight and Government Reform Committee Chairman James Comer opened an inquiry into whether CVS Caremark, Express Scripts and Optum Rx, three pharmacy benefit managers (PBMs), used audits to retaliate against independent pharmacies backing H.R. 6610.

On Oct. 23, Comer sent a letter to each company, seeking audit records and a staff-level briefing. The requests cover the kinds of audits conducted and the methods used to select pharmacies. They also seek counts of audits involving independent pharmacies in every state and territory, separated by affiliated and nonaffiliated organizations. Those counts are limited to independent pharmacies, rather than all pharmacy audits. The committee requested detailed records on independent pharmacy audits in Kentucky, Mississippi and Florida.

Comer's letter to CVS Caremark describes notices involving small prescription charges that reached pharmacies after stated compliance deadlines. His letter to Express Scripts raises a timing concern involving notices from several PBMs that listed due dates that had passed before pharmacies received them. In his letter to Optum Rx, Comer describes some pharmacies receiving their first audit notice, followed by two more soon after.

The committee also cited an audit over a medication priced at $0.99 that took hundreds of hours of staff time at an independent pharmacy. “The Committee will follow the facts and determine whether these audits were legitimate or were used to intimidate independent pharmacists,” Comer said. His letters request information and make no finding that the audits were retaliatory.

The inquiry follows the committee’s July advancement of H.R. 6610, the Pharmacists Fight Back in Federal Employee Health Benefit Plans Act. The bill would set reimbursement and rebate requirements for PBMs serving Federal Employees Health Benefits Program plans. It also would prohibit steering patients to affiliated pharmacies.

PBMs act as intermediaries in prescription coverage, connecting drugmakers, benefit plans and pharmacies. They negotiate rebates and fees with drugmakers, shape covered-drug lists and related policies, and reimburse pharmacies for prescriptions.

The companies were asked to brief committee staff by Oct. 30 and provide the requested documents by Nov. 6.