ALEXANDRIA, Va. – Testifying today in a House Energy and Commerce Committee Subcommittee on Health hearing, National Community Pharmacists Association CEO B. Douglas Hoey, pharmacist, MBA, will outline numerous ways large pharmacy benefit managers and their largely unregulated role in the supply chain have harmed patients and their access to pharmacy care and urge Congress to halt and dissolve the horizontal and vertical consolidation that has overtaken health care.
Since he last appeared before the committee in 2017 and warned of these issues, Hoey said in his written testimony, PBM power in the supply chain has only grown due to increased vertical and horizontal consolidation. “CVS Health acquired Aetna, Cigna acquired Express Scripts, UnitedHealth Group’s OptumRX acquired Change Healthcare and UnitedHealth Group is now the largest employer of physicians in the country,” he wrote. “Meanwhile, there are more than 4,100 fewer pharmacies today than four years ago. Horizontal and vertical consolidation in health care has not produced the efficiencies and consumer price reductions Americans were promised. Instead, it has created worse outcomes, higher costs, and rationing access for patients, employers, and taxpayers. It has created an uneven playing field for competitors and has directly harmed access to independent pharmacies.”
Patient steering, group purchasing organizations, “specialty drug” classifications, and other tactics used by these consolidated corporate entities increase costs and lower patient access and quality of care, Hoey said. Additional practices, he said, result in punitive audits and inadequate reimbursement for pharmacy competitors, also stifling healthy competition.
NCPA and its independent and long-term care pharmacy members applaud recent actions by Congress and the Federal Trade Commission, Hoey said. He also identified several additional actions they can take — such as breaking up these entities, prohibiting patient steering, requiring a transparent pharmacy reimbursement model, banning spread pricing, and accelerating implementation of the recently enacted “reasonable and relevant” PBM contract provisions — especially as “PBMs have historically adapted their corporate structures and shifted operational activities (including overseas entities) in ways that reduce transparency and frustrate oversight/reform efforts.”
To view Hoey’s written remarks and recommendations, click here.
To view the hearing, click here.
