The chair of a key House panel is pressing major pharmacy benefit managers on whether they retaliated against independent pharmacies for publicly supporting reform efforts.
House Committee on Oversight and Government Reform Chairman James Comer, R-Kentucky, submitted letters to the PBM industry’s “Big Three” firms — CVS Caremark, Optum Rx and Express Scripts — seeking documents and communications to determine whether they hit independent pharmacies with “punitive” audits in response to the push for PBM reform.
In the letters, Comer expresses concern that pharmacies saw an “unusual surge in burdensome audits” after independent pharmacies openly backed the Pharmacists Fight Back in FEHB Plans Act, according to an announcement.
“In the short span of time since the Committee’s July markup of H.R. 6610, the Pharmacists Fight Back in FEHB Plans Act, multiple independent pharmacies that supported the Committee’s efforts have received an unusual number of burdensome audit notices in short succession from several PBMs,” Comer wrote in the letter (PDF) to Express Scripts. “This includes audits for minuscule prescription charges and listed compliance deadline dates before the date of receipt of the audit notice.”
“This raises concern that these audit notices were sent or timed to retaliate for their support of H.R. 6610,” Comer said.
For example, Comer notes in the announcement a case in which an audit was tied to a medication costing 99 cents, and complying with the audit request required “hundreds of hours of staff time” for the pharmacy.
In the letters, Comer is requesting any documents, communications and staff-level briefings that include details on the company’s audit processes, pharmacy selection totals and national audit totals. The committee chair is also seeking specific records on audits for independent pharmacies in Kentucky, Florida and Mississippi.
Comer has a long history of advocating for PBM reform, and has been a vocal leader in that push since 2021. In 2024, the Oversight Committee released a report alleging the industry’s biggest firms “monopolized the pharmaceutical marketplace” through practices that harm community pharmacies and accusing PBMs of using anticompetitive pricing strategies.
Reform efforts have particularly focused on increasing transparency into PBM behaviors. Earlier this year, lawmakers included several PBM reforms in the bipartisan funding package, with provisions that seek to establish greater transparency in Part D.