PBMs Under Scrutiny: The Need for Greater Transparency and Oversight in Healthcare

During a House subcommittee hearing, it was proposed that pharmacy benefit managers (PBMs) should be held to a higher standard as fiduciaries, with the responsibility of prioritizing the best interests of health-plan beneficiaries by providing benefits and covering plan expenses. The hearing brought to light concerns about three major PBMs – CVS Health, Optum RX, and Express Scripts – which control a significant portion of the prescription drug market for self-insured health plans. These PBMs have significant influence over the drugs covered on health plan formularies and the rebates paid on those drugs.

Russell DuBose, vice president of human resources at Phifer Inc., based in Tuscaloosa, Alabama, voiced his concerns during the hearing. He argued that the dominance of these PBMs in the market raises questions about their impartiality and ability to act solely in the interests of health-plan beneficiaries.

The issue of transparency and accountability in PBM operations was also discussed during the hearing. Some participants called for greater oversight and regulation to ensure that PBMs are acting ethically and in the best interests of those they serve.

Overall, the hearing shed light on growing concerns about PBMs’ influence and power in healthcare. As such, there may be a need for increased regulation and oversight to ensure that PBMs fulfill their duties as fiduciaries and act in the best interests of health-plan beneficiaries moving forward.