NE Washington News

Congressman Earl L. "Buddy" Carter, Chairman of the Subcommittee on Health, addressed the issue of Pharmacy Benefit Managers (PBMs) during a hearing in Washington, D.C. The session focused on how controlling PBMs could increase competition and reduce costs for patients.

Carter began by highlighting the impact on patients, sharing the story of Mattie McCoy, a 16-year-old from Georgia who was denied access to a vital medication by CVS Caremark, resulting in hospitalization. "Let me be clear: PBMs’ greed sent a 16-year-old back to the hospital, in critical condition," he stated.

He criticized PBMs as hidden middlemen in the pharmaceutical supply chain that inflate prescription costs and restrict patient access to necessary treatments. According to Carter, three companies dominate over 80% of the PBM market due to consolidation and vertical integration.

Carter cited reports that independent pharmacies are reimbursed less than those owned by PBMs themselves. An audit revealed Optum paid its stores significantly more than independent pharmacies for identical drugs. He noted that this discrepancy led to over 300 independent pharmacy closures in 2023 alone.

The Federal Trade Commission's report highlighted substantial markups on essential generic drugs by PBMs. Additionally, an audit found Express Scripts overcharged nearly $45 million for a postal service health plan.

Carter expressed gratitude towards President Trump for his commitment to holding PBMs accountable and praised bipartisan efforts within the House Energy and Commerce Committee for pursuing reforms aimed at reducing drug costs and increasing transparency.

In closing, Carter emphasized the need for legislative action: "Americans deserve and expect protection from inflated prescription drug costs, forced pharmacy closures, and barriers to health care access."