Comer and Aderholt Continue PBM Probe, Urge CMS to Protect Patient Care Under New Bipartisan Reforms
WASHINGTON—House Committee on Oversight and Government Reform Chairman James Comer (R-Ky.) and House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies Chairman Robert Aderholt (R-Ala.) are continuing to investigate the role of Pharmacy Benefit Managers (PBM) in the pharmaceutical marketplace and their anticompetitive tactics driving up the cost of life-saving prescription drugs. In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet C. Oz, the Chairmen highlighted that Congress recently enacted bipartisan reforms to hold PBMs accountable and urged CMS to now use its authority to ensure patients can access appropriate care without unnecessary barriers imposed by PBMs.
“The House Oversight Committee exposed how the three largest PBMs colluded to line their own pockets. These self-benefitting pricing tactics have done nothing but jeopardize patient care, undermine local pharmacies, and raise prescription drug prices. Congress took action to advance legislative solutions to support patients and provide greater transparency in the PBM industry. While these new bipartisan reforms take effect, CMS must also ensure patients are protected and can access quality care without interference from PBMs. Americans deserve affordable medications, and Congress will continue to work in a bipartisan fashion to restore competition in the pharmaceutical marketplace,” said House Oversight Committee Chairman James Comer.
“The recently passed FY26 Labor, Health and Human Services, Education, and Related Agencies Appropriations Act includes bipartisan reforms aimed at regulating pharmacy benefit management (PBM) operations by expanding federal oversight and increasing transparency. With this legislation, Congress directed reforms to protect pharmacists and their patients from harmful payment practices that drive up costs for community pharmacies and compromises patient care. Our shared goal must always be to protect patients who need the therapies prescribed by their physicians, not ‘managed’ by PBMs. CMS must now follow our lead and use its existing authority to ensure that patients are supported and can receive proper care without PBM interference under the guise of ‘utilization management.’ Accountability is essential when it comes to patient health,” said Labor, Health and Human Services, Education, and Related Agencies Subcommittee Chairman Robert Aderholt.
Read the letter to CMS here.
Background:
On March 1, 2023, Chairman Comer launched an investigation into PBMs’ role in rising health care costs. In July 2024, Chairman Comer released a detailed report titled “The Role of Pharmacy Benefit Managers in Prescription Drug Markets,” presenting evidence that PBMs have inflated prescription drug costs and compromised patient care for their own financial gain. Following the report’s release, Chairman Comer praised the Federal Trade Commission for taking decisive action against the three largest PBMs and their affiliated group purchasing organizations for engaging in anticompetitive pricing practices. To date, the House Oversight Committee has held three hearings, including with the CEOs of CVS Caremark, Express Scripts, and OptumRx, to uncover harmful PBM practices and explore legislative solutions.