Why Such High Drug Prices

Today in the upstate health insurance agents are scrambling to make sure that the clients’ drugs are well covered by their Medicare Advantage Plans.

Otherwise, Medicare members could be in for a shock when they see  accelerated drug prices in January, when the new benefits begin.

What’s causing the spike in drug prices?

Congress has launched an investigation into the pharmacy benefit managers (PBMs). A statement says that “the PBMs are artificially inflating prices at the expense of the public.

The statement adds that such “tactics are harming patient care and increasing costs for consumers.” Chairman Comer is calling on the Office of Personnel Management (OPM), Centers for Medicare and Medicaid Services (CMS), and the defense Health Agency (DHA) for documents and communications to determine the extent such tactics impact healthcare programs administered by the federal government.

House Committee on Oversight and Accountability Chairman James Comer (R-Ky.) says in a statement that this practice is distorting the pharmaceutical market and limiting high quality care to patients.

Additionally, Chairman Comer is calling on the largest PBMs—CVS Caremark, Express Scripts, and OptumRx—to provide documents.

“Pharmacy Benefit Managers’ anticompetitive tactics are driving up health care costs for Americans and harming patient care. Federal agencies administering health care programs for seniors, active-duty military, and federal employees rely on PBMs as middlemen to set drug prices, which opens the door to government waste at the expense of American taxpayers. Greater transparency in the PBM industry is vital to determine the impact that their tactics are having on patients, the pharmaceutical market, and health care programs administered by the federal government. The House Oversight and Accountability Committee is shining a light on this issue in the healthcare system and will continue to examine solutions to make prescription drugs more affordable for all Americans,” said Chairman Comer.

CVS Health’s CVS Caremark, Cigna’s Express Scripts, and United Health Group’s OptumRx control an estimated 80 percent of the PBM marketplace. In Committee Republicans’ December 2021 report, initial findings revealed that large PBM consolidation has negatively impacted patient health, increased costs for consumers, forced manufacturers to raise their prices, and created conflicts of interest which distort the market and limit high quality care for patients.

Published: Mar 1, 2023