A bipartisan group of lawmakers has formally requested an investigation by the Department of Justice into the role of pharmacy benefit managers (PBMs) in the ongoing opioid epidemic.
The representatives highlighted concerns over collusion among the three largest PBMs—CVS Caremark, Express Scripts, and Optum Rx—in steering patients toward OxyContin.
Allegedly, these PBMs received financial incentives from Purdue Pharma, raising questions about their ethical practices.
The lawmakers referenced a report that detailed how these PBMs secured substantial rebates and fees from Purdue Pharma.
While these rebates are intended to benefit patients, the PBMs retained a significant portion of these funds.
The investigation into PBMs is driven by concerns over their market dominance and the implications for drug pricing and patient access.
The lawmakers pointed out that CVS Caremark, Express Scripts, and OptumRx collectively control over 80% of the market, raising concerns about their influence on drug coverage and pricing.
Internal documents revealed troubling agreements between Purdue Pharma and CVS Caremark, where rebates increased with higher coverage amounts of OxyContin.
Additionally, Express Scripts allegedly granted Purdue Pharma favorable formulary placement in exchange for a rebate.
The lawmakers emphasized the broader implications of vertical integration within the pharmaceutical supply chain, particularly in terms of patient care and drug affordability.
The concentration of power among PBMs affects pricing and limits patient access to essential medications.
The lawmakers called for greater oversight and accountability in PBM practices.
The Federal Trade Commission has indicated its intention to take action against the largest PBMs regarding their pricing negotiations.
The scrutiny of PBM practices is part of a larger conversation about the need for reform in the pharmaceutical industry, particularly in terms of patient welfare and transparency in drug pricing.