STAT+: House lawmaker probes PBMs for ‘punitive’ audits of independent pharmacies — SkimNews
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- James Comer (R-Ky.), who heads the House Committee on Oversight and Government Reform, sent letters late last week to CVS Caremark, OptumRx and Express Scripts — the three largest pharmacy benefit managers.
- Independent pharmacies experienced what Comer calls an "unusual surge in burdensome audits" after many of them openly backed the legislation he introduced last year.
- Pharmacists Fight Back Act — the bipartisan bill — is the measure at the center of Comer's inquiry into whether the three PBMs retaliated against pharmacies that supported it.
- Federal Employees Health Benefits Program: the bill would require PBMs participating in that federal program to fairly reimburse pharmacies for the actual cost of medicines and pay a reasonable fee for dispensing the drugs — even as the audit inquiry reaches the three largest PBMs.
Why it matters: For independent pharmacies, a congressional probe into audits from CVS Caremark, OptumRx and Express Scripts turns their compliance burden into a political grievance. For the three largest PBMs, the exposure comes from a specific mechanism: the Pharmacists Fight Back Act would let the federal employees program require reimbursement for medicines' actual cost plus a dispensing fee.
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