A group of legislators is calling on the Department of Justice to dig into whether pharmacy benefit managers played a role in the opioid epidemic.
The letter (PDF) was sent to Attorney General Merrick Garland last week and was signed by Reps. Buddy Carter, R-Georgia; Raja Krishnamoorthi, D-Illinois; Deborah K. Ross, D-North Carolina; and Cliff Benz, R-Oregon. The representatives point to recent reports that suggest the three largest PBMs worked together to funnel patients to OxyContin prescriptions.
“Recent reports, including confidential files and information from CVS Caremark, Express Scripts and Optum Rx, suggests the three largest PBMs colluded and conspired to steer patients towards Oxycontin in exchange for $400 million,” the legislators wrote.
The allegations stem from an October article in Barron’s that details the findings. The outlet reported that these three firms secured the $400 million in rebates and fees from Purdue Pharma across a yearlong period ending in late 2017.
Barron’s also reported that the PBMs in question largely pocketed the rebates rather than passing those savings on to consumers, according to the letter.
Beyond the opioid crisis, the letter also slams the major PBMs for being integrated with large health insurers as well as group purchasing organizations, pharmacies and other healthcare businesses. Vertical consolidation in healthcare has been a central concern for policymakers looking to reform the PBM industry.
Carter in particular has been a vocal critic of PBMs, as he is a pharmacist himself who owned an independent pharmacy chain in his home state. He hosts a section on his website dedicated to chronicling “PBM abuses.”
“The lack of transparency surrounding PBM’s rebate agreements and formulary decisions has allowed them to operate with little to no oversight, posing a significant threat to America’s public health,” the representatives wrote in the letter. “That is why we strongly urge the Department of Justice to investigate the role PBMs may have played in the opioid crisis and hold them accountable.”
PBMs are already embroiled in a legal fight with the feds over insulin prices. The Federal Trade Commission sued the three largest pharmacy benefit managers in September, alleging they forced patients to pay more for insulin by “rigging pharmaceutical supply chain competition in their favor.”
The companies have rejected these claims, and, in a countersuit filed last month, they argued that the charges are unconstitutional.